The Director of Member Experience is responsible for designing, leading, and executing strategies to improve Consumer Assessment of Healthcare Providers and Systems (CAHPS) performance across all of Partnership’s product lines. This role drives measurable improvement in member experience, Star Ratings, Health Plan Ratings and quality performance by integrating voice-of-the-member insights into enterprise strategy, operations, and provider engagement. The Director serves as a change leader and subject matter expert, ensuring the organization consistently delivers exceptional member experience that meets regulatory expectations and strengthens market competitiveness.

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 within established production and quality standards. Completes and processes reports and appropriately documents member records of actions taken to correct or update member records, PCP assignments etc. Processes reports to ensure primary care assignment is appropriate, processes certain authorized representative forms and document members records appropriately. Reports eligibility discrepancies and...

To initiate and coordinate a multidisciplinary team approach to case management. Engages the member/member’s representative in a care plan that assists the member in meeting his/her health and wellness goals. Collaborates, assesses, plans, facilitates, evaluates, and advocates to meet the comprehensive medical, behavioral, and psychosocial needs of the member, while promoting

The Configuration Analyst provides both operational support to, and analysis of, lower complexity Configuration-related activities. The Configuration Analyst creates, updates, tests and maintains system configuration to support all benefit designs and ensure successful configuration, integration, and accurate and timely payment of claims and all Partnership systems. Coordinates testing, quality assurance, configuration, installation, and support to ensure smooth, stable and timely implementation of technology solutions, considering all the areas that a change may impact in the current benefit setup and determine the most appropriate way to implement the change (e.g.,...

To provide administrative support to the department head, leadership team, and staff as assigned.

Perform routine and ad-hoc reporting and data management for internal and external users; assist in maintaining reporting systems within the department. To prepare, analyze, report, and manage data used for both plan-wide and regional decision making for evaluating performance in key quality measures and the effective use of health plan resources on a routine and ad hoc basis.

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.

The Business Telecom Manager is responsible for leading the strategic planning, coordination, and prioritization of telecom-related business initiatives across departments. This role acts as the liaison between business units and the technical telecom team, ensuring that communication solutions align with organizational goals and operational needs. The manager will oversee business requirements gathering, feature tracking, and release planning for VOIP, voicemail, call recording, and other telecom services. This position works in tandem with Information Technology as the business arm to telecom, ensuring that business needs are clearly defined, prioritized, and translated into actionable

The Senior Network Engineer plays a critical role in ensuring the stability, performance, and security of the organization’s network infrastructure. This position is responsible for designing, implementing, and supporting complex network solutions that meet evolving business and operational needs. As an experienced member of the IT Operations Team, the Senior Network Engineer serves as a technical expert and escalation point for network issues. The role involves deep expertise and hands-on work across routing, switching, firewalls, and emerging technologies such as SD-WAN and network automation, and may also serve as a technical lead for a small team of Network Engineers, providing...

This position is responsible for working with Indian Health Services and Tribal Communities in Partnership HealthPlan of California (Partnership) assigned counties. Participates in the design, implementation, and/or expansion of strategic programs and departmental initiatives in relationship to tribal and Indian health services deliverables. Develops and delivers program goals, measures, and reports. The Liaison will be responsible for a range of functions to improve the physical, behavioral and oral health of American...

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

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 review, research, and resolve claims for all Medi-Cal claim types within established production and quality standards, including manual processing. Creates appropriate documentation that reflects the actions taken and status of the claim. Generates provider communication, such as letters. Routes and tracks claims requiring review by other staff and departments, and processes when possible.

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

To plan, organize, manage, and implement projects.

Under the general direction of the CIO, the Director, IT Strategic Initiatives is responsible for overseeing IT strategic initiatives; developing, implementing, and auditing methodologies and best practices related to steering committees; and prioritization of projects and best practices related to the Systems Development Life Cycle (SDLC). The Director will be responsible for ensuring that there is a consistent development and implementation process and that it is followed. The Director will work with the CIO and other department directors to prioritize projects and provide status reports to the CIO and Steering Committee.

Perform routine and ad-hoc reporting and data management for internal and external users; assist in maintaining reporting systems within the department. To prepare, analyze, report, and manage data used for both plan-wide and regional decision making for evaluating performance in key quality measures and the effective use of health plan resources on a routine and ad hoc basis.

The DSNP Project Manager is responsible for coordinating activities related to the Dual Eligible Special Needs Plan (DSNP) lifecycle. This role ensures compliance with CMS requirements, timely execution of deliverables, and seamless collaboration across internal teams and external partners and will oversee strategic project planning and manage all aspects of AEP operational readiness including all impacted business functions. This position will effectively manage assigned projects, utilizing appropriate project management methodologies to drive the planning, implementation, and tracking of projects through all aspects of the project...

The Housing Services Coordinator is responsible for reviewing, approving, and supporting requests for housing-related services for Community Supports services offered by the health plan. This role ensures that housing related services are appropriate, align with program criteria, and support members stability and health outcomes. The position works closely with departmental clinical teams, care management teams, external

To support the overall financial success of Partnership by providing senior level responsibilities in the preparation and analysis of Generally Accepted Accounting Principles (GAAP) financial statements, statutory financial reports, budget development and internal operational reports.  Position maintains a significant role in the maintenance of the general ledger and the month end close process.  The Senior Accountant is responsible for or assists with the maintenance and configuration of the accounting systems as well as being an advance user.  The Senior Accountant has excellent analytical skills and a thorough knowledge of accounting principles to analyze financial reports...