Medical Case Manager (LVN) (LTSS) (Complex Discharge) CalOptima CalOptima Health is seeking a highly motivated an experienced Medical Case Manager (LVN) (LTSS) (Complex Discharge) to join our team. The Medical Case Manager (LVN) for Long Term Support Services (LTSS) is part of an advanced specialty collaborative practice, responsible for case management, care coordination, authorization and utilization management of the assigned population of focus (Community Adult Based Services (CBAS), CalAIM,
QI Nurse Specialist (LVN) CalOptima CalOptima Health is seeking a highly motivated an experienced QI Nurse Specialist (LVN) to join our team. The Quality Improvement (QI) Nurse Specialist (LVN) for Utilization Management (UM) is responsible for overseeing UM for CalOptima Health's direct network and delegated Health Network teams. The incumbent will be responsible for ensuring standards are met for operational and oversight compliance and UM operations are consistent with regulatory requirements
Clinical Auditor, Sr. CalOptima CalOptima Health is seeking a highly motivated an experienced Clinical Auditor, Sr. to join our team. The Clinical Auditor Sr will serve as the auditor for clinical and quality areas within the Case Management department. The incumbent will ensure regulatory (Medicare and Medi-Cal including Whole Child) and accreditation National Committee for Quality Assurance (NCQA) compliance for all CalOptima Health lines of business by conducting routine oversight, monitoring
