careers-partnershiphp

Overview To review, research, and resolve claims for all Medi-Cal claim types within establishedproduction and quality standards, including manual processing. Creates appropriatedocumentation that reflects the actions taken and status of the claim. Generates providercommunication, such as letters. R

Overview To review, research, and resolve claims for all Medi-Cal claim types within establishedproduction and quality standards, including manual processing. Completes and processes claimsand claims worksheets. Creates appropriate documentation that reflects the actions taken andstatus of the claim

Overview The Manager of Care Coordination (CC) will lead and support the department leadership in thedevelopment, implementation and evaluation of Partnership’s clinical case management services.Collaborates with Supervisor(s) to oversee the department activities and provides guidance tomanage these

Overview To support in the planning, organization, management, and implementation of projects. Responsibilities  Supports the successful implementation of projects with a range of low to mediumcomplexity, scope, and schedule. Supports in the development and maintenance of project plans and budget

Overview To establish and maintain excellent relationships with the provider network in a specific geographic region, including healthcare practitioners, office staff, and administrators. Works closely to identify and resolve complex issues, provides education and staff training. Provides service an

Overview The compliance analyst plays a key support role in ensuring the department maintainscompliance with regulatory, accreditation, and internal standards. This role is responsible forreporting, evidence gathering, data validation, trend review, operational follow-up, assisting withpolicy and th

Overview This position provides support and guidance to Partnership HealthPlan of California (Partnership) members for wellness services and incentive programs in a call-center environment. The Wellness Guide works closely with members and their families to encourage members to engage in healthy act

Overview To support the Claims Department in maintaining pended claims and claim adjustments withinestablished guidelines. Reviews and processes complex claims, and supports claims examining. Responsibilities ESSENTIAL DUTIES AND RESPONSIBILITIES- Researches and processes claim adjustment requests.-

Overview The Enrollment Specialist I will assist in maintaining Medi-Cal membership and process basic functions of the Enrollment Unit. This position will review, research, and resolve Medi-Cal eligibility issues and systems related errors as well as primary care physician (PCP) assignment failures

Overview Represents Partnership in the Grievance & Appeals Resolution process. Responsible for reviewing,investigating, and resolving assigned member grievance and appeal cases ranging from low tohigh complexity. Works to transform member dissatisfaction into member satisfaction. Overseesthe investi

Overview The Coordinator I will provide coordination and administrative support to department teams andmanagement. Performs a variety of general clerical duties, including data entry, reportgeneration, manage and respond to call inquiries, manage internal Helpdesk inquiries, manageand assign follow

Overview To develop, implement, improve, and manage assigned programs. In addition to the ProgramManager II duties, the Senior Program Manager is a leadership role, has a higher level ofeducation/experience, more autonomy, exercises independent judgment, and provides coachingand guidance to less exp

Overview To be the active project manager to deliver successful projects. Sets and follows clear project management standards including project plans, risk registers, and other project management documents. Responsible for the successful delivery of IT projects and assists in developing standards, m

Overview To provide administrative support to the executive leader, leadership teams, and staff asassigned. In addition to the Administrative Assistant II duties, the Executive Assistant has a higherlevel of education and experience and more autonomy, works with a higher level ofinternal/external cu

Overview To initiate and coordinate a multidisciplinary team approach to case management. Engages themember/member’s representative in a care plan that assists the member in meeting his/her healthand wellness goals. Collaborates, assesses, plans, facilitates, evaluates, and advocates to meet thecomp

Overview To initiate and coordinate a multidisciplinary team approach to case management. Engages themember/member’s representative in a care plan that assists the member in meeting his/her healthand wellness goals. Collaborates, assesses, plans, facilitates, evaluates, and advocates to meet thecomp

Overview The Coordinator II will coordinate assigned departmental projects and provide complexadministrative support to department leaders. Develops, implements and monitors processes,tools, and systems for collecting, tracking and managing information required for monitoringperformance and deadline

Overview To provide administrative support to the department head, leadership teams, and staff as assigned. In addition to the Administrative Assistant I duties, the Administrative Assistant II has a higher level of experience and more autonomy, is involved in project coordination, identifies necess

Overview To supervise employees working in the assigned areas of responsibility within the ConfigurationDepartment. Maintains the accuracy and completeness of assigned projects and programs perPartnership and State of California Medi-Cal guidelines and department director instruction. Developsand ex

Overview Supervise the day-to-day operations of Partnership HealthPlan of California’s (PHC) credentialing functions. Provide leadership, support, training, and direction to the Provider Relations Credentialing Specialist staff. Ensure the highest level of accuracy and timeliness of credentialing fu