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.

To supervise the Medi-Cal Claims Customer Service Specialists and Customer Service Representatives. 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 Training and Education Coordinator will design the training program for the Utilization Management (UM) Department’s data platforms, medical necessity software, and department policies and procedures in consultation with UM Supervisors and Managers

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)

To assist in the day-to-day operations and management of the Member Services Department. Provides leadership and support and direction to Member Services staff.

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

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)

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 Senior Healthcare Data Analyst I contributes to the overall success of the organization by developing analytic solutions that support activities related to health services utilization management, care coordination, quality improvement and population health. Through analyzing patient claims, member enrollment, and other data, the Senior Healthcare Data Analyst

The State Hearing Representative has overall responsibility for assigned State Hearings, court cases for Partnership members contesting the outcome of Appeals and/or Grievances decisions. This position will represent Partnership HealthPlan of California at Department of Social Services (CDSS) court hearings. Responsible for establishing course of action to resolve conflict with Partnership members, case research, preparation of legal documents, coordination of internal resources, submission of cases to CDSS, conducting case hearings, and final outcome. Negotiates case withdrawals with Partnership members. May handle ADA 1557 discrimination cases. May handle high-profile and staff-complaint...

Under the direction of the Provider Payment Strategy Manager, this position will support the development, evaluation, and advancement of provider reimbursement methodologies to align with organizational strategies and objectives, including performance and alternative payment approaches, and advise executive-level leadership regarding the feasibility of various strategies.

Supervise the day-to-day operations of Partnership HealthPlan of California’s (Partnership) 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 functions, including delegation oversight.  Train and monitor staff in the delivery of excellent customer service.

Under the direction of the Supervisor of Instructional Design, this position: designs and develops innovative and engaging eLearning courses; administers training courses to Partnership HealthPlan of California staff; and performs other duties as assigned.

Under the direction of the CIO, the Director of IT Business Systems will be responsible for overseeing the end-to-end intake, evaluation, and formalization of new technology initiatives, including software requests, solution proposals, IT evaluation of licensing agreements, and software-related contracts. This position will serve as the critical liaison between business units

Works closely with business users and the IT Business Systems Management Team to conduct thorough analyses of project initiatives, contributing to the creation of comprehensive documentation for the preliminary stages of project development. This includes identifying stakeholders, documenting project initiation details, writing business requirements/user stories,