The Senior IT Project Manager is responsible for the successful delivery of large-scale, complex projects often involving multiple internal and external stakeholders through all phases of the SDLC. The Senior IT Project Manager helps set and follow clear project management standards including project plans, change controls, risk management, and other project management documents on given strategic initiatives. The Senior IT Project Manager assists in developing standards, managing the enterprise IT project priority list with IT Directors, and assists in IT Steering Committee meetings if needed. This position reports to the Director of IT Strategic...

To provide daily oversight, leadership, support, training, and direction of Population Health staff. Supports and assists the Team Manager in developing and maintaining a cohesive team with a high level of productivity and accuracy to achieve the department's overall performance metrics.

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 and education via onsite visits and telephone. Assists providers with understanding Partnership HealthPlan of California's policies and procedures and assists with resolving issues that arise.

To assist in the negotiation, development, implementation, and maintenance of new and existing professional, facility, and ancillary contracts for the Partnership provider network. The Contract Specialist will also be responsible for supporting daily contracting activities as follows:

Train examiner and customer service level I staff on all related claim types for all Partnership lines of business using AMISYS Advance system and Claims Operating Instruction Memorandums.

To research and resolve complex claims issues which cross interdepartmental lines and communicate the outcome to providers and affected Partnership managers. D

To provide coordination and implementation support of defined tasks for the assigned program(s). In addition to the Program Coordinator I duties, the Program Coordinator II has a higher level of experience, conducts business analysis to evaluate programs, tracks and reports data to a higher complexity level, coordinates daily activities, communicates program status to stakeholders, and confirms that outcomes are meeting program requirements.

To assist and support the Director with development, implementation, and maintenance of professional, facility, and ancillary contracts for the Partnership provider network. The Contracts Coordinator II is responsible for, Contracting Department tracking, and reporting provider network activities, including of scanning contract documents, mailing or emailing network notices related

Works closely with business users and IT to write business requirements, test plans, implementation plans, and other project documentation. Understands and supports users with Partnership applications and assists in trouble shooting issues. Usually works on small to medium size projects but may work on larger projects depending on the situation. May assist the Senior IT Business Analyst on more complex projects.

Under the direction of the Utilization Management (UM) Supervisor or above, this position will conduct audits of assigned areas, assist in department audit initiatives as well as perform audits in accordance with the department audit plan. As an integral member of the Training and Development Team, this position will help the audit function keep pace with the audit needs of

To support the Claims Department in maintaining pended claims and claim adjustments within established guidelines. Reviews and processes complex claims, and supports claims examining.

To accurately perform concurrent, retrospective, and special audits on all level I claim types for all Partnership lines of business.

To provide coordination and implementation support of defined tasks for the assigned program(s).

To supervise the Medi-Cal Claims Specialists and Examiners. Ensures delivery of highest level of customer service to the community and its medical providers.

To supervise the Medi-Cal Claims Specialists and Examiners. Ensures delivery of highest level of customer service to the community and its medical providers.

To supervise the claims auditors; claims fraud, waste, and abuse coordinators and the related job functions for each position. Ensures delivery of highest level of customer service to the community and its medical providers.

Supervision of the Medi-Cal customer service outreach functions. Ensures delivery of the highest level of provider claims training to medical providers and the community.

To review, research, and resolve claims for all Medi-Cal claim types within established production and quality standards, including manual processing. Completes and processes claims and claims worksheets. Creates appropriate documentation that reflects the actions taken and status of the claim. Generates provider communication, such as letters, as necessary. Routes and tracks claims requiring review by other staff and departments, and processes when possible. Claims Examiner II is distinguished from Claims Examiner I by a higher level of autonomy and experience, as well as an ability to process a wider range of claim types.

To provide daily supervision of utilization management staff. Provide departmental leadership, support, resources and direction to staff. Assists in developing and maintaining a cohesive team with a high level of productivity, accuracy and quality to achieve departmental goals and objectives.

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 accreditation standards. Reviews both draft and final All Plan Letters (APLs)