To prepare, analyze, report, and manage compliance of PHC’s Wellness & Recovery program, through both internal and external efforts. Works collaboratively with departments companywide to identify data needs, develop and maintain tools, and complete accurate reporting of compliance.

The Epidemiologist will work with the Chief Medical Officer and collaboratively with Health Services leaders and stakeholders to plan, design, implement, and analyze data for key projects and initiatives. The Epidemiologist will monitor population health outcomes, provide recommendations for improvement, evaluate program practices, and contribute to evidence-based decision-making in support of Partnership’s mission.

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 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. 

Provide advisory and technical services to all of the health-plan’s contact center organizations (Member Services, Health Services, Claims, PR, and Admin) in the areas of operations, system enhancement & configuration, report generation, knowledge management, and training. Conduct business and technical requirements analysis, testing, and execution in support of the development of PHC’s contact center systems enhancements and reports. Develop and maintain an understanding of PHC’s contact center systems and reporting tools as an administrator and a user. Develop and deliver custom daily, weekly, monthly, quarterly, and yearly reporting with contact center metrics,...

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

Responsible for the development of all processes necessary to complete all phases of the Enterprise Data Warehouse (EDW). This includes source identification, data collection, data transformation, normalization, rule administration, error detection and correction, data consolidation, data storage, data distribution, schema mapping, data enrichment, and data governance.

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