To supervise the day-to-day operations of all auditing functions for the PR Department. Provides supervision, support and guidance to the PR Audit staff. Monitors inventory and disseminates work based on timeliness standards and competing priorities.

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

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

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

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.

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 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 support the Claims Department in maintaining pended claims, corrected claim inquiries and claims adjustment projects within established guidelines. Reviews and processes complex claims, supports claims examining, while offering additional training or support to the Claims Specialist Team.

To plan, organize, manage, and implement projects.

Under supervision of the Regulatory Affairs and Compliance (RAC) leadership, this supports the plan-wide HIPAA program and Fraud, Waste, and Abuse (FWA) program and acts as a liaison between the plan and our regulatory agencies. This position coordinates daily efforts between departments to conduct investigations into potential privacy or FWA related incidents, assess and mitigate risk as well as develop corrective action plans when applicable. This position supports the plan’s compliance program and assists in efforts to be compliant with applicable laws, regulations, and policies.

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.

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.

The Accountant III (Payroll Specialist) is responsible for the processing, auditing and analyzing of payroll, providing data support to related payroll filings and maintaining the payroll database. Additionally, this position will support the analysis of employee benefits by conducting various database audits, create the base schedules for the annual FTE budget and complete the month end close responsibilities related to employee salary, wages and benefits.  

To effectively lead assigned projects, utilizing appropriate project management methodologies to drive the planning, implementation, and tracking of projects through all aspects of the project lifecycle. Project Managers are responsible for the planning, procurement, and execution of a project. 

This position is responsible for coordinating all trainings facilitated through Training & Development. Responsible for assisting in maintaining accurate employee data in systems managed by the Training & Development team. Provides the necessary assistance to the Training & Development team with a high level of integrity, strong organizational skills, and

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.