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 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

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.

Under the direction of the Director of Quality and Performance Improvement (QI/PI), the Manager of Performance Improvement is responsible for key initiatives within the QI/PI Department: - The Partnership Improvement Academy and its associated programs; - Strategic, organization-wide improvement initiatives; - Focused...

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.

To support in the planning, organization, management, and implementation of projects.

To design, develop, and test data transformations processes and related process automation at PHC.  To work with the Manager of Web Application Development in the design, development, testing, maintaining and migrating the databases and its related processes. Works closely with web Development team to maintain databases and its documentation. 

At Partnership HealthPlan of California, the Microsoft 365 Solutions Engineer plays a key role in supporting and optimizing the organization’s Microsoft 365 environment to enable secure, efficient, and collaborative digital operations. This position is responsible for the architecture, administration, and lifecycle management of core Microsoft 365 services, including Exchange

To be the active project manager to deliver successful projects. Sets and follows clear project management standards including project plans, risk registers, and other project management documents. Responsible for the successful delivery of IT projects and assists in developing standards, managing the enterprise IT project priority list, and IT Steering Committee meetings. 

The Medicare Operations Analyst is responsible for ensuring operational excellence across delegated entities during implementation and post Go-Live implementation for Medicare DSNP program. In collaboration with the respective department, this role oversees implementation and post-implementation day-to-day operations including enrollment, claims processing, utilization/case management (UM/CM), and call center performance. The Analyst will monitor, audit, and collaborate with delegated partners to ensure adherence to CMS regulations, organizational policies, and contractual requirements. Review daily/weekly/monthly operational reports.

This position manages, configures, and maintains Partnership’s HR systems, such as the learning management system (LMS), performance management system, health and wellness system, external content providers, and the employee engagement system. This individual will ensure that all managed systems will meet all regulatory compliance needs and verify data accuracy and

To design, develop, and test client server and web applications at PHC. To work with the Director of Web Applications Development in the design, development, testing, and deployment of web and desktop applications. Works closely with IT staff in developing applications for business needs supporting AMISYS Advance and networked systems. The Senior Web Applications Developer is responsible for designing, developing, testing, and supporting Web Applications.

Oversees the organizational and technical support for the data warehouse. Accountable for the delivery and maintenance of the data warehouse architecture and business intelligence framework that meets the short and long term goals of Partnership.

To develop, implement, improve, and manage assigned programs. The Program Manager I is responsible for the overall success for the assigned program(s) and their role extends beyond completion of individual tasks. Programs are ongoing, which may include aligned projects and requires strategic planning and continuous improvement efforts after program startup.

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

Under the direction of the Cost Avoidance Supervisor, the Cost Avoidance Specialist I monitors activities related to cost savings and recoveries of medical claim payments; identifies and verifies members other health coverage (OHI), updates system and recovers overpayment, and researches and validates provider refund checks. The Cost Avoidance Specialist interfaces with all departments in an information sharing capacity to promote proper payment procedures and timely cost effectiveness in claims payments.

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

The Benefits Auditor is responsible for ensuring accuracy, compliance, and timely administration of employee benefit programs through detailed auditing, reconciliation, and billing support activities. This role conducts regular audits of benefit enrollments, deductions, and vendor data to identify and investigate discrepancies and ensure data integrity. The position performs bi-weekly audits to validate employee eligibility, enrollment changes, payroll deductions, and benefit plan records across HRIS, payroll, and vendor systems. Ensures and maintains compliance with company policies and federal and state laws.

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.