In collaboration with Care Coordination team members, this position provides support and guidance to HealthPlan members referred to the Care Coordination Department for Case Management services and programs. The Health Care Guide I works closely with members, families, providers, community agencies, and the interdisciplinary care team to assist in coordination of benefits in a timely and cost-effective manner, while connecting members to available internal and external resources.

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

The Mental Health Manager is responsible for the management of mental health services, which includes multiple work groups of significant depth and complexity. Responsibilities include overall management of this service area, including working with the Behavioral Health Administrator for the development of the service areas objectives and design and implementation of supporting and expansion programs, processes, policies, and/or procedures to successfully achieve those objectives.

The Coordinator I will provide coordination and administrative support to department teams and management. Performs a variety of general clerical duties, including data entry, report generation, manage and respond to call inquiries, manage internal Helpdesk inquiries, manage and assign follow up inquiries from other departments, creates and revises desktop protocols, and develops forms and presentations.

Under the direction of the Sr. Internal Audit or above will conduct audits of assigned areas, assist in the internal audit initiatives as well as perform audits in accordance with the annual audit plan. As an integral member of the Internal Audit team, help the audit function keep pace with the audit needs of the organization. Applies industry standard audit procedures and documents findings in

The G&A Nurse Supervisor provides clinical and operational supervision to the Grievance & Appeals nursing team, including Nurse Specialists, Sr. Nurse Specialists, and State Hearing Representatives. The Nurse Supervisor maintains an active clinical caseload while overseeing the daily operations, workload distribution, and performance of the clinical team. The Nurse

Part of a multidisciplinary team, responsible for clinical oversight of assigned grievance and appeal cases. Utilizes clinical judgement in the assessment, solution, and/or guidance of cases to ensure members receive high quality healthcare services. Working closely with PHC Medical Directors, oversees assessments for medically necessary determinations, quality of care

To respond to member and provider calls regarding Plan policies, procedures, membership, eligibility, benefits, and claims, providing the highest level of customer service. In addition to the Member Services Representative duties, the Lead Member Services Representative has a higher level of experience, monitors call queues, assists with training material, and handles complex calls that cannot be resolved by the Member Services Representatives.

This position will assist in the management of hardware, software and licensing. Additionally they will work to ensure all procedures are followed in the purchasing of hardware, software and licenses. The person in this position will analyze system data, prepare purchase orders, solicit bid proposals and review requisitions. This position will ensure all IT purchases are completed in a timely manner, in compliance with current Partnership HealthPlan of California (PHC) purchasing and contracting policies, and in alignment with IT and PHC strategic plan. This position will also work with the Chief Information Officer (CIO) and/or designee in the review

The incumbent utilizes clinical judgement in providing utilization management services. The focus is to provide high quality, cost-effective care which will enable patients to achieve maximum medical improvement while receiving care deemed medically necessary. Assists in determining appropriateness, quality and medical necessity of treatment plans using pre-established guidelines. This position may be assigned cases in long-term care and ancillary, DME or medical services.

To plan, organize, manage, and implement projects.

The Coordinator I will provide coordination and administrative support to department teams and management. Performs a variety of general clerical duties, including data entry, report generation, manage and respond to call inquiries, manage internal Helpdesk inquiries, manage and assign follow up inquiries from other departments, creates and revises desktop protocols, and develops forms and presentations.

To lead and participate in the development of complex software systems and programs at Partnership. Collaborates with the IT Director in the analysis, design, programming utilizing specifications and applying programming standards, troubleshooting, problem resolution, maintenance, and documentation of software systems and programs. Oversees all aspects of

In collaboration with Care Coordination team members, this position provides support and guidance to HealthPlan members referred to the Care Coordination Department for Case Management services and programs as well as other staff within the department. The Health Care Guide II exercises a high degree of judgment, discretion, initiative, consistency and independence when working with members, families, providers, community agencies, and/or the interdisciplinary team.

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.

The Coordinator II will coordinate assigned departmental projects and provide complex administrative support to department leaders. Develops, implements and monitors processes, tools, and systems for collecting, tracking and managing information required for monitoring performance and deadlines. Develops and produces reports. In addition to the Coordinator I duties, the Coordinator II may handle escalated calls, escalated Helpdesk inquiries, and may follow up with providers regarding missing documentation.

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 develop, implement, improve, and manage assigned programs. In addition to the Program Manager I duties, the Program Manager II has a higher level of experience, more autonomy, exercises independent judgement, and conducts business analysis and program analytics. Programs are ongoing, which may include aligned projects and requires strategic planning and continuous improvement efforts after program startup. Participates in the design, implementation, and/or expansion of strategic programs and departmental initiatives. Develops and delivers program goals, measures, and reports.

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 necessary efficiencies, and is exposed to confidential information.

The Coordinator II will coordinate assigned departmental projects and provide complex administrative support to department leaders. Develops, implements and monitors processes, tools, and systems for collecting, tracking and managing information required for monitoring performance and deadlines. Develops and produces reports. In addition to the Coordinator I duties, the Coordinator II may handle escalated calls, escalated Helpdesk inquiries, and may follow up with providers regarding missing documentation.