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Caloptima Jobs (NOW HIRING)

CalOptima

QI Nurse Specialist (RN) (PQI)

Orange, CA · Hybrid

QI Nurse Specialist (RN) (PQI) CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and ...

Casa de la Familia

Care Coordinator

Santa Ana, CA

$20 - $27/hr

Conduct outbound and inbound calls with CalOptima ECM members. * Engage members and assist with ECM enrollment and participation. * Schedule appointments and coordinate services with healthcare ...

New

CalOptima Health

Social Worker (PACE)

Garden Grove, CA · Hybrid

May be required to perform home visits to private homes of CalOptima Health's PACE participants; frequent travel in Orange County. * Support PACE participants with care coordination needs, such as ...

CalOptima Health

Social Worker (PACE)

Garden Grove, CA · Hybrid

May be required to perform home visits to private homes of CalOptima Health's PACE participants; frequent travel in Orange County. * Support PACE participants with care coordination needs, such as ...

Aroha Technologies

Social Worker - Full Telework

Orange, CA · On-site

$32.70 - $52.31/hr

CalOptima Health, Orange, CA 92868 Full-Time | Monday - Friday, 8:00 a.m. - 5:00 p.m. Salary Range: $32.70 - $52.31/hour About the Role Aroha Technologies, a trusted healthcare staffing partner with ...

Alfred A Sidhom M D Inc

Medical Biller

Anaheim, CA

$18 - $23/hr

Timely submission of claims to variety of insurance payers including PPO's, HMO's, Medicare, Medi-Cal, and CalOptima. * Follow up unpaid claims and work toward resolution. * Resolve billing ...

Aroha Technologies

Care Manager (Temporary)

Orange, CA · On-site

$35 - $52/hr

CalOptima Health via Aroha Technologies Inc. Care Manager (Temporary) Full Office | Monday-Friday, 8:00 AM-5:00 PM Salary Range: ($34.66 - $55.4582) $72,096 - $115,353 annually Job Overview CalOptima ...

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Caloptima information

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How much do caloptima jobs pay per hour?

As of Jun 24, 2026, the average hourly pay for caloptima in the United States is $26.34, according to ZipRecruiter salary data. Most workers in this role earn between $15.14 and $30.77 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a CalOptima Case Manager, and why are they important?

To thrive as a CalOptima Case Manager, you need a solid background in healthcare, case management, and knowledge of Medi-Cal or public health programs, typically supported by a degree in nursing, social work, or a related field. Familiarity with case management software, electronic health records (EHR), and state or federal health regulations is essential. Strong interpersonal skills, cultural competency, and problem-solving abilities make someone stand out in this position. These skills ensure effective patient advocacy, compliance with health policies, and the delivery of coordinated, high-quality care for vulnerable populations.

What are some common challenges faced by CalOptima employees in serving a diverse member population?

CalOptima employees often work with members from a wide range of cultural, linguistic, and socioeconomic backgrounds. A common challenge is ensuring clear communication and understanding diverse health needs, which may require using translation services or adapting outreach strategies. Team members collaborate with case managers, healthcare providers, and community organizations to deliver tailored support, making cultural competence and adaptability crucial skills. Overcoming these challenges is highly rewarding, as it directly contributes to improved health outcomes for underserved populations.

What is CalOptima and what does it do?

CalOptima is a county-organized health system in Orange County, California, that administers health insurance programs for low-income residents. Its main programs include Medi-Cal, OneCare (HMO SNP), and the Program of All-Inclusive Care for the Elderly (PACE). CalOptima coordinates health care services such as primary care, specialty care, mental health, and pharmacy benefits for its members. The organization works with a network of doctors, hospitals, and other providers to ensure members receive quality, accessible health care. Eligibility for CalOptima programs is generally based on income, age, and health status.

What is the difference between Caloptima vs Medical Billing Specialist?

AspectCaloptimaMedical Billing Specialist
CredentialsTypically requires knowledge of healthcare programs, insurance policies, and possibly certifications in healthcare administrationRequires knowledge of billing procedures, coding, and often certifications like CPC or CPC-H
Work EnvironmentGovernment or healthcare organization setting, focusing on Medicaid/Medicare programsMedical offices, hospitals, or billing companies handling insurance claims
Employer & IndustryPublic health agencies, managed care organizationsPrivate healthcare providers, billing companies
Search & Comparison IntentUnderstanding roles within healthcare administration and insurance programsLearning about billing procedures and certifications

Caloptima is a managed care organization focusing on Medicaid services, while a Medical Billing Specialist handles insurance claims and coding in healthcare settings. Both roles involve healthcare administration but differ in scope and specific responsibilities.

More about Caloptima jobs
What cities are hiring for Caloptima jobs? Cities with the most Caloptima job openings:
What job categories do people searching Caloptima jobs look for? The top searched job categories for Caloptima jobs are:
Caloptima jobs near you
Program Specialist, Medi-Cal & CalAIM

Program Specialist, Medi-Cal & CalAIM

CalOptima

Orange, CA • Hybrid

Full-time

Retirement, PTO

Posted 12 days ago

CalOptima rating

9.1

Company rating: 9.1 out of 10

Based on 15 frontline employees who took The Breakroom Quiz

24th of 261 rated insurance

Job description


Program Specialist, Medi-Cal & CalAIM
CalOptima
Join Us in this Amazing Opportunity
The Team You'll Join
We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.
More About the Opportunity
We are hoping you will join us as a Program Specialist, Medi-Cal & CalAIM and help shape the future of healthcare where you'll be an integral part of our Medi-Cal & CalAIM team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Full Office.
  • If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.

The Program Specialist (Medi-Cal and CalAIM) will provide comprehensive support for CalOptima Health's CalAIM program, including Enhanced Care Management, Community Support services and the Community Health Worker benefit, while also contributing to broader Medi-Cal projects. You will be responsible for administrative responsibilities, service coordination and program monitoring to ensure effective operations and improved member outcomes.You will work closely with internal teams, contracted providers and community partners to facilitate seamless care delivery and program success. Together, we are building a stronger, more equitable health system.
Your Contributions To the Team:
  • 80% - Program Support
    • Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
    • Assists the department in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
    • Works with cross-functional teams to support the implementation, monitoring and evaluation of CalAIM services, activities and reports.
    • Assists with developing auditing tools, conducting audits of contracted providers and providing recommendations for compliance and quality improvement plans.
    • Communicates with necessary external partners, providers and stakeholders to ensure accurate program updates, reminders and relevant information are distributed in a timely manner.
    • Assists in developing and updating program material, including training workshops that support effective program implementation.
    • Coordinates regulatory reporting for assigned programs and prepares memos, documents, reports and forms as needed.
    • Stays updated on Department of Health Care Services (DHCS) CalAIM program requirements, policy changes and outcomes.
    • Enters data into CalOptima Connect portal and other CalOptima Health information systems as needed.
    • Supports the achievement of CalOptima Health's vision and goals for its CalAIM program as defined in its Program Guides and policies.
  • 15% - Administrative Support
    • Coordinates calendars and schedules of the CalAIM program, including scheduling appointments, prepping meeting materials, taking minutes, coordinating travel, meetings and events, evaluating needs and scheduling meeting arrangements.
    • Provides administrative support for specific and/or ongoing projects, such as generating reports, collecting data and maintaining project tracking logs.
    • Maintains confidential and sensitive information and files regarding management projects, policies and personnel while ensuring appropriate follow-up.
    • Responds to Street Medicine referral calls and directs inquiries to the appropriate provider while offering support via phone and electronic communication during regular business hours, ensuring all incoming questions are addressed within one business day.
    • Coordinates and monitors email communication with external partners for the CalAIM initiative.
  • 5% - Other
    • Completes other projects and duties as assigned.

Do You Have What the Role Requires?
  • Bachelor's degree in health policy, health care economics, public policy, public health, sociology, psychology, social work or a related field PLUS 1 year of experience providing support in program development, implementation and operations or related experience in a managed health care organization required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
  • Have access to means of transportation for work away from the primary office approximately 20% of the time required.

You'll Stand Out More If You Possess the Following:
  • 2 years of experience working with health care delivery systems and/or in a public agency/organization serving Medi-Cal, Medicare or any other under resourced populations.
  • 2 years of experience working with community-based organizations.
  • Bilingual in English and one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).

What the Regulatory Agencies Need You to Possess?
  • N/A

Your Knowledge & Abilities to Bring to this Role:

  • Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
  • Work independently and exercise sound judgment.
  • Communicate clearly and concisely, both orally and in writing.
  • Work a flexible schedule; available to participate in evening and weekend events.
  • Organize, be analytical, problem-solve and possess project management skills.
  • Work in a fast-paced environment and in an efficient manner.
  • Manage multiple projects and identify opportunities for internal and external collaboration.
  • Motivate and lead multi-program teams and external committees/coalitions.
  • Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Your Physical Requirements (With or Without Accommodations):
  • Ability to visually read information from computer screens, forms and other printed materials and information.
  • Ability to speak (enunciate) clearly in conversation and general communication.
  • Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
  • Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
  • Lifting and moving objects, patients and/or equipment 10 to 25 pounds

Ways We Are Here For You
  • You'll enjoy competitive compensation for this role.
    • Our current hiring range is: Pay Grade: 305 - $55,966 - $83,949 ($26.91 - $40.3601).
      • The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors.
  • This position is approved for Full Office (**If the position is Telework, it is eligible in California only**)
  • A comprehensive benefits package
  • CalPERS pension program and additional retirement packages.
  • Additional benefits and perks including:
    • A generous PTO program
    • A quality work life balance
    • Various wellness programs
    • Tuition Reimbursement
    • Professional development opportunities
    • Career development opportunities
    • Flexible scheduling
    • And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.

Our Work Environment:
If located at the 500, 505 Building or a remote work location:
  • Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
  • There are no harmful environmental conditions present for this job.
  • The noise level in this work environment is usually moderate.

If located at PACE:
  • Work is typically indoors in a clinical setting serving the frail and elderly.
  • There may be harmful or hazardous environmental conditions present for this job.
  • The noise level in this work environment is usually moderate to loud.

If located in the Community:
  • Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
  • Employee will occasionally work outdoors in varied temperatures.
  • There may be harmful or hazardous environmental conditions present for this job.
  • The noise level in this work environment is usually moderate to loud.

Why Join Us?
We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare.
What's Your Next Step?
All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is June 24, 2026 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.
Our Commitment to You
Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview.
If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet.
We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process.
CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.
To apply, please visit: https://jobs.caloptima.org/jobs/program-specialist-medi-cal-calaim-505-city-parkway-west-california-united-states
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