Responsible for assisting the HR Manager or above with the administration of Human Resources functions including HR Reporting, Personnel Actions Forms, and other human resources functions. Researches and assesses impact of proposed policies, legislation, or programs, and recommends activities or changes as appropriate. Works with staff on activities aimed at ensuring employee satisfaction and effectiveness. Interprets Human Resources policies and procedures for Partnership staff.

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

To initiate and coordinate a multidisciplinary team approach to case management. Engages the member/member’s representative in a care plan that assists the member in meeting his/her health and wellness goals. Collaborates, assesses, plans, facilitates, evaluates, and advocates to meet the comprehensive medical, behavioral, and psychosocial needs of the member, while promoting

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 develop, implement, improve, and manage assigned programs. In addition to the Program Manager II duties, the Senior Program Manager is a leadership role, has a higher level of education/experience, more autonomy, exercises independent judgment, and provides coaching and guidance to less experienced program managers. 

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 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.  Participates in the design, implementation, and/or expansion of strategic programs and departmental initiatives. Supports the development and execution of program goals, outcome measures, and program reporting.

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....

Perform routine and ad-hoc reporting and data management for internal and external users; assist in maintaining reporting systems within the department. To prepare, analyze, report, and manage data used for both plan-wide and regional decision making for evaluating performance in key quality measures and the effective use of health plan resources on a routine and ad hoc basis.

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.

The Accountant III (Payroll Specialist) is responsible for the processing, auditing and analyzing of payroll, providing data support to related payroll filings and maintaining the payroll database. Additionally, this position will support the analysis of employee benefits by conducting various database audits, create the base schedules for the annual FTE budget and complete the month end close responsibilities related to employee salary, wages and benefits.  

Perform routine and ad-hoc reporting and data management for internal and external users; assist in maintaining reporting systems within the department. To prepare, analyze, report, and manage data used for both plan-wide and regional decision making for evaluating performance in key quality measures and the effective use of health plan resources on a routine and ad hoc basis.

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 Business Telecom Manager is responsible for leading the strategic planning, coordination, and prioritization of telecom-related business initiatives across departments. This role acts as the liaison between business units and the technical telecom team, ensuring that communication solutions align with organizational goals and operational needs. The manager will oversee business requirements gathering, feature tracking, and release planning for VOIP, voicemail, call recording, and other telecom services. This position works in tandem with Information Technology as the business arm to telecom, ensuring that business needs are clearly defined, prioritized, and translated into actionable

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.

Perform routine and ad-hoc reporting and data management for internal and external users; assist in maintaining reporting systems within the department. To prepare, analyze, report, and manage data used for both plan-wide and regional decision making for evaluating performance in key quality measures and the effective use of health plan resources on a routine and ad hoc basis.

The DSNP Project Manager is responsible for coordinating activities related to the Dual Eligible Special Needs Plan (DSNP) lifecycle. This role ensures compliance with CMS requirements, timely execution of deliverables, and seamless collaboration across internal teams and external partners and will oversee strategic project planning and manage all aspects of AEP operational readiness including all impacted business functions. This position will effectively manage assigned projects, utilizing appropriate project management methodologies to drive the planning, implementation, and tracking of projects through all aspects of the project...