In addition to the Enrollment Specialist duties, the Enrollment Unit Lead (EUL) provides assistance to team members as well as the Enrollment Unit Supervisor. The EUL provides subject matter expertise and serves as an escalation point for Enrollment Specialists, assisting with complex member and provider issues as they occur. 

Under direction of the Manager or above, provides supervision of the assigned Grievance staff, and assists in the day-to-day operations in the Grievance Unit by providing leadership, direction, and support to Lead Grievance Coordinators, Grievance Coordinators, and Grievance Resolution Specialists.

Implements Partnership HealthPlan of California (PHC) communications strategies through impactful member engagement, digital engagement, media relations, legislative affairs, community relations, branding, and communications with PHC stakeholders.

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

To plan, organize, manage, and implement projects.

To serve as first level production support for conference rooms, desktops, phones, printing, software and other computer related operations.  Analyzes, investigates, and resolves reported issues. Determines underlying sources for problems and escalates issues to next level of support if necessary.

To plan, organize, manage, and implement projects.

Under the direction of the Manager of Performance Improvement, the Improvement Advisor is uniquely positioned to drive improvement across PHC, our provider network, and the communities we serve. The Improvement Advisor will work internally and externally with provider practices and community partners to identify, plan, and facilitate quality improvement projects. Via

To provide high-level support for day-to-day PC operations, production operations support, systems and telecommunications support. Support and lead all help desk functions with PC troubleshooting, performing software updates and maintaining the inventory of PC’s and network systems hardware. Serve as the primary and second level escalation point for desktop, VoIP, A/V, and connectivity support to internal customers/ end-users. Supports IT Operations efforts in the building with implementation, testing, and deployment of new servers, and software, systems, network, and security changes. Primary operations support to production environment, maintains necessary skills related to production support,...

Works closely with business users and the IT Business Systems Management Team to conduct thorough analyses of project initiatives, contributing to the creation of comprehensive documentation for the preliminary stages of project development. This includes identifying stakeholders, documenting project initiation details, writing business requirements/user stories,

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 develops forms and presentations.

To support the financial reporting and analytical processes by analyzing actual performance against budget for profit and loss information and other data in order to identify, evaluate, and communicate drivers of performance. Develops, coordinates, and is directly involved in projects and activities that help drive business decisions, affect provider reimbursement programs such as P4P, and provider capitation configuration. Works collaboratively with staff in Finance/Accounting in the ongoing analysis and reporting of all aspects of the income statement and other operating metrics.

To plan, organize, manage, and implement projects.

Provides assistance with oversight during the daily operations of the outpatient review process. Participates in the training and mentoring of team members. Provides support, resources, and direction to staff. Assists in determining appropriateness, quality, and medical necessity of requested service

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 provide Basic Population Health Management services for members which includes engaging with members individually or as part of a group to support lifestyle modifications to manage chronic diseases, to identify care gaps and needed services, and to aid Partnership members in maintaining wellness. Healthy Living Coaches shall also serve as a resource about Partnership as well as Population Health programs and services.

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

Under the general supervision of department leadership, the Quality and Training Supervisor will lead the design and structure of the department’s Quality Assurance (QA) and training program. Responsibilities include: designing, developing, implementing, and managing all quality and training activities for the department. Additionally, the supervisor is responsible for driving the attainment of quality metrics and to achieve superior results. Through demonstrated individual performance, the Quality and Training Supervisor shall promote the highest standards of ethical and professional conduct to lead staff members by example.

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.

Part of a multidisciplinary team, responsible for clinical oversight of assigned grievance and appeal cases. Utilizes clinical judgement in the assessment, solution, and/or guidance of cases to ensure members receive high quality healthcare services. Working closely with PHC Medical Directors, oversees assessments for medically necessary determinations, quality of care concerns, allegations of abuse, fraudulent acts or wasteful activity. Provides clinical leadership to Grievance & Appeals Case Analysts to ensure clinical solution followed on casework. Ensures casework complies with DHCS guidelines, NCQA standards, and PHC best practices. Works independently, prioritizes case deliverables, remains customer-focused and stays...