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60 Caloptima Utilization Management Coordinator Jobs Hiring Near You

CHPW

Utilization Management Coordinator I

Seattle, WA · On-site +1

$21 - $28.98/hr

The level I UM Coordinator is responsible for administrative functions in processing Utilization Management (UM) organization determinations for services requiring authorization and hospital ...

IntePros

Utilization Management RN

Philadelphia, PA · On-site

$63.18/hr

Care Management Coordinator/RN MAX BILL RATE: $63.18/hr Position is remote - candidate must reside ... Prioritizing candidates with direct hospital utilization experience. Job Summary The Care ...

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Caloptima Jobs Information

Do workers at CalOptima get paid breaks?

Yes. Most people get paid breaks.
79% of people say they get paid breaks.
Based on data from 14 people who took the Breakroom Quiz between May 2025 and May 2026.

Does CalOptima pay people when they’re sick?

Yes. Most people get paid when they’re sick.
79% of people say they would get paid if they were sick but scheduled to work.
Based on data from 14 people who took the Breakroom Quiz between May 2025 and May 2026.

At CalOptima, are sick days and vacation days separate paid time off?

Sick days and vacation days are used from the same paid time off.
100% of people say they have to use vacation days when they’re out sick.
Based on data from 11 people who took the Breakroom Quiz between May 2025 and April 2026.

Is the health insurance from CalOptima affordable enough for their workers?

Most people say the health insurance costs are okay.
100% of people say the health insurance costs are okay
Based on data from 12 people who took the Breakroom Quiz between May 2025 and April 2026.

Do people get paid time off at CalOptima?

Most people get paid time off work.
92% of people say they get paid time off.
Based on data from 12 people who took the Breakroom Quiz between May 2025 and April 2026.

Do workers at CalOptima worry about hours?

Most people don’t worry about getting enough hours.
100% of people report they don’t worry about getting enough hours.
Based on data from 7 people who took the Breakroom Quiz between May 2025 and April 2026.

Do CalOptima workers get to choose the shifts they work?

Most people get to choose which shifts they work.
80% report that they have enough control over which shifts they work.
Based on data from 5 people who took the Breakroom Quiz between May 2025 and April 2026.

How easy is it for CalOptima workers to change shifts?

Most people find it easy to change shifts.
100% of people report that it’s easy to change shifts if they need to.
Based on data from 5 people who took the Breakroom Quiz between May 2025 and April 2026.

How easy is it to get time off at CalOptima?

Most people find it easy to get time off.
100% of people report it’s easy to get time off.
Based on data from 10 people who took the Breakroom Quiz between May 2025 and April 2026.

Do CalOptima managers change schedules at the last minute?

Most managers don’t change people’s schedules at the last minute.
100% of people say their manager doesn’t change their shift schedule at the last minute.
Based on data from 6 people who took the Breakroom Quiz between May 2025 and April 2026.

Do jobs at CalOptima spill into time workers aren’t paid for?

Rarely. The job doesn't usually spill into unpaid time.
33% of people report that their job takes up time that they don’t get paid for.
Based on data from 6 people who took the Breakroom Quiz between May 2025 and April 2026.

How easy is it to take sick days at CalOptima?

Most people find it easy to take sick days.
92% of people report that it’s easy to take time off if they are sick.
Based on data from 13 people who took the Breakroom Quiz between May 2025 and May 2026.

Is working at CalOptima good if you’re a parent or caregiver?

Most parents and caregivers say this is a good place to work.
80% of people who care for a child or other relative report this is a good place to work.
Based on data from 5 people who took the Breakroom Quiz between May 2025 and April 2026.

Do people at CalOptima feel treated with respect by their managers?

Most people feel treated with respect by their managers.
86% of people say they’re treated with respect by their managers.
Based on data from 14 people who took the Breakroom Quiz between May 2025 and May 2026.

Do people at CalOptima get to take their breaks without interruption?

Most people get breaks without interruption.
93% of people report that they get to take their breaks without interruption.
Based on data from 14 people who took the Breakroom Quiz between May 2025 and May 2026.

Is it stressful to work at CalOptima?

Most people feel stressed out here.
73% of people say they often feel stressed out at work.
Based on data from 15 people who took the Breakroom Quiz between May 2025 and May 2026.

Do people at CalOptima enjoy their jobs?

Most people enjoy their job.
71% of people report they enjoy their job.
Based on data from 14 people who took the Breakroom Quiz between May 2025 and May 2026.

Do people at CalOptima recommend working with their team?

Only some people recommend working with their team.
47% of people report that they wouldn’t recommend working with their immediate team to a friend.
Based on data from 15 people who took the Breakroom Quiz between May 2025 and May 2026.

Do people get enough training when they start at CalOptima?

Some people didn’t get enough training when they started.
43% of people report they didn’t get enough training when they started working here.
Based on data from 14 people who took the Breakroom Quiz between May 2025 and May 2026.

Do people get support to advance at CalOptima?

Most people are given support to advance their career here.
In the last year, 80% of people report being given support to advance their career here.
Based on data from 15 people who took the Breakroom Quiz between May 2025 and May 2026.

Do people think CalOptima’s headquarters understands what’s happening where they work?

Some people think headquarters doesn’t understand what’s happening where they work.
58% of people think that this employer’s headquarters or owners don’t have a good understanding of what’s really happening where they work.
Based on data from 12 people who took the Breakroom Quiz between May 2025 and April 2026.

Do workers feel well informed about how CalOptima is doing?

Most people feel well informed about how the company is doing.
93% of people feel that they are kept well informed about how the company is doing as a whole.
Based on data from 15 people who took the Breakroom Quiz between May 2025 and May 2026.
What other companies are hiring for Utilization Management Coordinator jobs?
What are the most popular jobs at Caloptima?

UTILIZATION MANAGEMENT COORDINATOR II MSO

NORTH EAST MEDICAL SERVICES

Burlingame, CA • On-site

$39.69 - $45.10/hr

Full-time

Medical, Dental, Vision, Retirement

Re-posted 6 days ago

Job description

The Utilization Management Coordinator II functions under the direct supervision of a physician or Registered Nurse performing utilization management (UM) and care coordination duties for the NEMS MSO. The UM Coordinator II will also provide basic training to the junior UM Coordinators.

ESSENTIAL JOB FUNCTIONS:

  • Responsible to review Referral Requests and Treatment Authorization Requests received daily; process and approve authorization requests according to the NEMS MSO Authorization Grid and established clinical guidelines.
  • Provide guidance to junior UM Coordinators during research of additional clinical guidelines from different sources for complex cases.
  • Responsible to lead the junior UM Coordinators to prepare and present complex cases to Medical Director for review and ensure follow up activities.
  • Responsible for reviewing the confirmed MD approval/modification/denial decision and notes for record tracking purposes.
  • Responsible to prepare UM Notice of Action (NOA) to provider and member for UM denial decision per AB1455 turn-around-time requirement.
  • Responsible for preparing UM statistical reports and submit to health plans per contract requirement.
  • Perform Care Coordination activities with members, families, specialists, and ancillary providers for authorized services.
  • Perform case investigation for member and/or provider complaints and appeals related to UM denials, and report findings to Health Plan.
  • Provide transition of care services to members who are discharged from the hospital.
  • Perform customer services for UM inquires to PCP, specialist, and members.
  • Stay current with DHCS regulations, Health Plan agreements, and Industry Standard guidelines applicable to healthcare programs.
  • Communicate with Health Plan for clarification about clinical guidelines for covered/uncovered benefits.
  • Communicate UM related information and updates to all members of the health care team, patients, and their families.
  • Follows the appropriate turnaround timeframe for decisions and notification of members and providers.
  • Performs other job duties as required by manager/supervisor.
     
  • BS/BA Degree in Health Science or General Education highly preferred.
  • Minimum of one year of experience in utilization management required.
  • Recent experience in a clinic or outpatient setting desirable; able to perform efficiently and appropriately in a busy environment.
  • Current Medical Assistant Certification or California Pharmacy Technician License or equivalent experience in a health care field is a plus.
  • Knowledge of medical terminology is a must
  • Strong communication, analytical, and problem-solving skills.
  • Knowledge of community resources and cultural needs.
  • Good organization and prioritization skills, outstanding in time management.

LANGUAGE:

  • Must be able to fluently speak, read and write English.
  • Fluent in Chinese (Cantonese and/or Mandarin) preferred.
  • Fluent in other languages is an asset.

STATUS:

  • This is an FLSA Non-exempt position.
  • This is not an OSHA high-risk position.
  • This is a full-time position. 

NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).
 

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