CalOptima Health

The Director will be responsible for the oversight, planning, organization, implementation, and evaluation of all activities and personnel within the Behavioral Health Utilization Management department, ensuring compliance with all regulations and standards. Key contributions involve leadership functions (50%) such as directing staff and managing budgets, and program oversight (45%) including coordinating utilization activities and maintaining authorization review processes.

The Data Warehouse Programmer/Analyst will be responsible for designing, building, and operating large-scale enterprise cloud data platforms while driving the evolution of the data governance framework. This involves ensuring the delivery of reliable, scalable, and high-quality data pipelines that power analytics, reporting, and data science initiatives.

The Senior Programmer will design, develop, and implement software applications, manage multi-tasking projects, and perform complex analytical assignments related to Electronic Data Interchange (EDI). Key duties include developing and maintaining complex ETL SSIS packages, serving as a full-stack developer, and building highly responsive web user interfaces using technologies like Angular JS and .NET/Core.

The Medical Case Manager is responsible for reviewing and processing requests for authorization and notification of behavioral health services from various providers, utilizing established medical criteria and policies. This role involves direct interaction with providers, screening cases for Medical Director review, and completing necessary documentation in the utilization management system.