To oversee the appropriateness and quality of care delivered through Partnership HealthPlan of California and for the cost-effective utilization of services.

The Senior Data Analytics and Reporting Developer serves as a technical leader in the design, development, and optimization of enterprise-level data reporting solutions. This role is responsible for architecting advanced dashboards, automated reporting pipelines, and analytical models that empower strategic decision-making across the organization. The Senior Developer collaborates with business leaders, drives best practices, mentors team members, and ensures data quality, scalability, and performance across reporting systems.

To develop and maintain HIPAA compliant ANSI X12 transactions and support in EDI and other application development at PHC. Responsibilities include designing, coding, testing, and implementing each of the federal and/or state mandated transactions and other EDI applications using tools & technologies such as Edifecs’s Smart Trading including Spec Builder, Enterprise

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 design, develop, and test data transformations processes and related process automation at Partnership.  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. 

Responsible for the development of all processes necessary to complete SDLC phases of the Web Applications and Automation projects. This includes understanding of business processes, source identification, process design, data collection, data transformation, normalization, error detection and correction, data storage, data linage management, data achieving, and ETL Process oversight for web applications.

To design, develop, and test client server and web applications at Partnership. To work with the Director, Web Applications Development in the design, development, testing, and deployment of web and desktop applications. Works closely with IT staff in developing applications in business needs supporting AMISYS Advance and networked systems. Assumes senior role in developing applications and supporting existing applications and other applications, as appropriate.

To design, develop, and test client server and web applications at Partnership. 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.

The Manager of Web Applications Development is responsible for managing concurrent web and desktop development initiatives, including project level resource assignments, time estimates, and project planning details. The manager works with the Director of Web Application Development to prioritize projects, define and establish policies and procedures designed to ensure consistently high quality deliverables and high IT service performance. Lead development team through the Project and SDLC life cycles, from concept design to launch to maintenance, utilizing version control, bug tracking, and related change control processes....

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 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 Data Analytics and Reporting Developer is responsible for designing and developing data reports and dashboards that provide actionable insights to support business decisions. This role involves working closely with cross-functional teams to gather reporting requirements, transform data, and deliver high-quality, interactive visualizations. The position ensures data accuracy and

To process TARs for selected services using specific procedures and protocol and to provide administrative assistance to UM Coordinators and Leadership staff as assigned. Serves as Systems Trainer for all new hires and provides ongoing education for all HS/UM staff.

Train examiner and customer service level I staff on all related claim types for all Partnership lines of business using AMISYS Advance system and Claims Operating Instruction Memorandums.

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.

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.