Job Listings

To facilitate access to medical care by coordinating Non-Emergency Medical (NEMT) Transportation, Non-Medical Transportation (NMT) transportation and travel-related benefits for members. Coordinates care in collaboration with internal and external partners to help members overcome barriers to care created by lack of transportation.

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.

The Accountant II-Cash Management (Banking Operations) position will be a key member of the cash management team and is responsible for various treasury functions, including monitoring and recording of daily bank transactions, completing month end close and reconciliation activities related to bank and investment account activity and will assist in the completion and analysis of various cash and treasury related reports such as the cash flow statement, cash flow projections and investment reports. Banking activity includes managing the information flow from the banks and to the banks.   This position will be one of the main points of contact for external parties such as bankers and State AR from DHCS as well as internal partners such as IT to ensure payments to and from PHC are appropriately accounted for.

The Accountant II-Cash Management (Accounts Receivable) position will be a key member of the cash management team and is responsible for various cash and invoicing functions, including the invoicing and posting of cash receipts for Leased Tenants, Wellness and Recovery Drug Medi-Cal Counties and other entities as required. This position will be the main point of contact for inquiries related to such invoices.   This position will possess excellent communication skills as they will not only respond to billing inquiries but will also manage the Cash Management Helpdesk and address inquiries on a timely basis.

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.

To develop and implement long-term quantitative analysis strategies to meet NCQA and DHCS standards for reporting. To perform, and assist in the performance of, duties that ensure the accuracy, completeness and truthfulness of enterprise wide regulatory reporting including all data, information and documentation submitted to PHC’s governing agencies. Works collaboratively with all PHC department subject matter experts (SME) to implement new regulatory reporting requirements or templates and assist in troubleshooting regulatory reporting issues. To develop and implement strategies to meet NCQA standards for the oversight of delegate reporting. Supports the plan-wide Privacy and Fraud, Waste and Abuse (FWA) program by preparing trend analysis, forecasting reports and managing data collection in EthicsPoint.

Under supervision and direction of the Regulatory Affairs Manager, this position assists in supporting the plan-wide HIPAA program and Fraud, Waste, and Abuse (FWA) program and acts as a liaison between the plan and our regulatory agencies. This position coordinates daily efforts between departments to conduct investigations into potential privacy or FWA related incidents, assess and mitigate risk as well as develop corrective action plans when applicable. This position supports the plan’s compliance program and assists in efforts to be compliant with applicable laws, regulations, and policies.

To support the objectives of the regulatory and compliance program and to ensure related activities are in alignment with regulatory requirements, contractual obligations, and ethical standards.

To provide coordination and implementation support of defined tasks for the assigned program(s). In addition to the Program Coordinator I duties, the Program Coordinator II has a higher level of experience, conducts business analysis to evaluate programs, tracks and reports data to a higher complexity level, coordinates daily activities, communicates program status to stakeholders, and confirms that outcomes are meeting program requirements.

To provide coordination and implementation support of defined tasks for the assigned program(s).

The Manager of Care Coordination (CC) will lead and support the department leadership in the development, implementation and evaluation of Partnership’s clinical case management services. Collaborates with Supervisor(s) to oversee the department activities and provides guidance to manage these functions to enhance cost effectiveness, ensure compliance with applicable state and federal regulations, and to fulfill all contractual requirements.

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 facilitate access to medical care by coordinating Non-Emergency Medical (NEMT) Transportation, Non-Medical Transportation (NMT) transportation and travel-related benefits for members. Coordinates care in collaboration with internal and external partners to help members overcome barriers to care created by lack of transportation.

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.

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.

In collaboration with the HR Recruiters coordinates the ongoing recruitment and selection of industry experienced and leadership positions for Partnership HealthPlan of California (PHC) by providing assistance and administrative support. Professionally represents PHC in frequent interactions with applicants, all levels of staff, and the public. Holds employee and applicant confidentiality in the highest regard.

This position works with the Benefits team to administer the entire Employee Benefits Program, Workers’ Compensation Program, Benefits Open Enrollment Program, and PHC sponsored Employee Life Insurance. The Benefits Coordinator is responsible for providing a full range of HR customer service support. This position also performs general HR benefits duties such as administrative and clerical support, organizing and scheduling meetings, and other duties as assigned.

Under the general direction of the Associate Director of Health Analytics, this position is responsible for managing the Health Analytics Team at PHC. The goal of the Health Analytics Team is to help PHC improve the health of our members and the communities we serve by developing and producing high quality analytic reports of health care data for use internally and externally. To achieve this, the Manager of Health Analytics will manage, mentor, and train a group of highly motivated and highly qualified health analysts, working collaboratively with the Data Warehouse Team and the Financial Analysis Team. Collectively these three units (Health Analytics, Financial Analysis, and Data Warehouse) provide the analyst workforce and analytic infrastructure for PHC.

The Sr. Manager of HRP Transaction Management will oversee and manage HRP Transaction Management functions effectively. This entails leading a team, prioritizing tasks, establishing and enforcing standards, training staff, testing and implementing new code, analyzing user requirements, and aligning work with business priorities.

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 individualized facilitation, this position will coach and train improvement teams to build team members’ quality improvement (QI) skills, develop their organizational capacity for QI work, and help them meet their specific QI goals. In addition to working directly with improvement teams, the Improvement Advisor will join PHC’s Performance Improvement training team, and will facilitate workshops and learning collaborative sessions on topics such as improvement methodology, QI measurement, process improvement, project management, and change management.