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.

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.

Primary duty of the CSR III is to routinely process CIFs. They will be responsible to learn all CIF claim types within 18 months of accepting position.

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 coordinate medically necessary behavioral health treatment services for adults and children with behavioral health needs. Screens, collaborates and coordinates care as part of the multidisciplinary team to evaluate and advocate for the medical, behavioral and psychosocial needs of the member while promoting quality outcomes.

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.

Under direction from the Director of Utilization Management, manages and provides direction to the Health Services department Managers for all product lines ensuring consistent development, implementation, and maintenance of health services programs and achievement of department goals and objectives, in a fast paced, ambiguous environment. Ensures compliance with established criteria and Partnership benefits. 

The Internal Auditor is an important position to ensure quality case investigations within the Grievance & Appeals Department (G&A). The auditor assesses the quality of all grievance and appeal cases to ensure they meet DHCS-mandated requirements, NCQA specifications, and Partnership professional standards.  Conducts individual audits of grievance, appeal, exempts, and State Hearing cases completed by the Grievance staff. Identifies and recommends improvements to advance the overall quality of investigation outcomes.

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

To research and resolve provider telephone and written inquiries within established time frames, accurately screen claims, and participate in provider meetings and projects. To accurately research and process paper and electronic medical, outpatient, ancillary, long term care, CHDP, encounter data and paper crossover/other coverage claims within established time frames, applying appropriate program policies related to claims processing and analysis.

To analyze and interpret financial data and procedures to prepare financial information and reports. Applies generally accepted accounting principles and procedures (GAAP) to record, classify, and examine financial transactions. Participates in Month End Close responsibilities such as journal entry creation to book expenses and accruals, uploads these items to accounting system and reconciling sub ledger accounts. Participates in annual financial audit by preparing requested audit schedules and responding to ad hoc audit requests. Responds to customer base (i.e. employees, outside vendors, members) in a timely and professional manner

The Manager of Medicare Marketing and Sales will oversee the development and execution of Partnership’s Medicare D-SNP marketing and sales strategy focused on driving smart and measurable growth. The Marketing manager will lead a team that collaborates with Partnership leadership to understand the unique opportunities within each market and deliver on sales and retention goals.

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.