careers-partnershiphp

Overview To develop, implement, improve, and manage assigned programs. The Program Manager I isresponsible for the overall success for the assigned program(s) and their role extends beyondcompletion of individual tasks. Programs are ongoing, which may include aligned projects andrequires strategic p

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

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 To respond to member and provider issues and inquiries. Ensures that callers’ questions and/or problems are resolved or are directed to the appropriate person for resolution and provides the highest level of customer service. Responsibilities Responds to member and provider issues and quest

Overview To provide coordination and implementation support of defined tasks for the assignedprogram(s). Responsibilities  Supports the execution of existing program activities, including data entry, tracking, andreporting. Tracks and compiles program data for program team analysis/review. Monito

Overview To provide coordination and implementation support of defined tasks for the assignedprogram(s). Responsibilities  Supports the execution of existing program activities, including data entry, tracking, andreporting. Tracks and compiles program data for program team analysis/review. Monito

Overview To research and resolve provider telephone and written inquiries within established timeframes,accurately screen claims, and participate in provider meetings and projects. Support for eitherescalated calls or to accept calls of a more complex nature requiring additional skills. To providesu

Overview The Policy Analyst will be responsible for drafting, editing, reviewing, auditing, tracking,monitoring and maintaining policies and procedures for Partnership HealthPlan of California.Alongside designated organizational leadership, ensures compliance with governing rules,regulations, and/or

Overview To respond to member and provider issues and inquiries. Ensures that callers’ questions and/or problems are resolved or are directed to the appropriate person for resolution and provides the highest level of customer service. Responsibilities Responds to member and provider issues and quest

Overview To review, research, and resolve claims for all Medi-Cal claim types within established productionand quality standards, including manual processing. Completes and processes claims and claimsworksheets. Creates appropriate documentation that reflects the actions taken and status of theclaim

Overview To begin Treatment Authorization Requests (TAR) reviews and perform data entry upon TAR determination by pharmacy staff. Performs eligibility and benefit investigations. Supports pharmacy department with extracting and collecting data for reporting needs. Supports department's administrativ

Overview The Regulatory Affairs Specialist II has demonstrated competencies in supporting the plan-wide regulatory affairs and compliance program, including activities related to HIPAA, Fraud, Waste, and Abuse (FWA), and compliance issues. As such, conducts investigations to effectively prevent, det

Overview The Data Integration Developer is responsible for designing, developing, and maintaining dataintegration solutions with a focus on EDI (Electronic Data Interchange) for healthcareapplications. This role involves implementing ETL processes, managing data pipelines, ensuringdata quality, and

Overview Responsible for the development of all processes necessary to complete SDLC phases of the Web Applications and Automation projects. This includes understanding of business processes, source identification, process design, data collection, data transformation, normalization, error detection

Overview To design, develop, and test client server and web applications at PHC. To work with the Director, Web Applications Development in the design, development, testing, and deployment of web and desktop applications. Works closely with IT staff in developing applications in business needs suppo