Job Listings


Here are our current job openings. Please click on the job title for more information, and apply from that page if you are interested.

Use this form to perform another job search

The system cannot access your location for 1 of 2 reasons:
  1. Permission to access your location has been denied. Please reload the page and allow the browser to access your location information.
  2. Your location information has yet to be received. Please wait a moment then hit [Search] again.
Click column header to sort

Search Results Page 1 of 3

Job Locations US-CA-Fairfield
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.
Job ID
2021-2042
FLSA Status
Non-Exempt
Job Locations US-CA-Fairfield | US-CA-Eureka | US-CA-Redding
To plan, implement, and analyze lifestyle-change program activities to members of Partnership Healthplan. Support participants, provide guidance, and lead members to develop sustainable healthy lifestyles. On behalf of Partnership Healthplan, engages members individually in groups and through multiple modalities that may include telephonic, web-based tools, and through participation in community events.
Job ID
2021-2041
FLSA Status
Exempt
Job Locations US-CA-Eureka
To engage with community-based organizations, providers, school districts, and other external agencies in order to understand the services and support systems available within the community, facilitate collaboration and alignment between Partnership HealthPlan of California (PHC) and community efforts, and to identify gaps in needed services for the wellness needs of PHC’s population.
Job ID
2021-2040
FLSA Status
Exempt
Job Locations US-CA-Fairfield
To maintain accurate provider information by entering all necessary data elements into several database systems. Reviews forms for completeness and researches discrepancies. Ensures all information is updated timely within departmental standards. Responds to routine provider telephone inquiries via telephone and email.
Job ID
2021-2038
FLSA Status
Non-Exempt
Job Locations US-CA-Fairfield
Leads the design of the training program for the Provider Relations (PR) Department’s provider demographic database and the provider data master (PDM) system in consultation with PR Supervisors and Managers. Develops training materials and guides. Trains new PR staff and facilitates ongoing training. Performs auditing activities and recommends training topics for staff based on audit results. Performs all activities related to auditing, tracking, and documenting staff performance of operational processes with an emphasis on ensuring provider data and other work output is accurate. Produces audit reports to identify trends for training opportunities.
Job ID
2021-2037
FLSA Status
Non-Exempt
Job Locations US-CA-Fairfield
Represents PHC in the Grievance & Appeals Resolution process. Responsible for reviewing, investigating, and resolving assigned member grievance and appeal cases ranging from low to high complexity. Works to transform member dissatisfaction into member satisfaction. Oversees the investigative process ensuring casework complies with DHCS guidelines, NCQA standards, and PHC best practices. Works independently, provides leadership on each investigation, prioritizes case deliverables, remains customer-focused, and stays current on changes in the healthcare system that may trigger member dissatisfaction.
Job ID
2021-2036
FLSA Status
Exempt
Job Locations US-CA-Fairfield
Under the direction of the Organizational Development Manager, this position: designs and develops innovative and engaging eLearning and Instructor-Led Training (ILT) courses; administers training courses to Partnership HealthPlan of California (PHC) staff; and performs other duties as assigned.
Job ID
2021-2032
FLSA Status
Exempt
Job Locations US-CA-Fairfield
To plan, organize, manage, and implement projects.
Job ID
2021-2031
FLSA Status
Non-Exempt
Job Locations US-CA-Fairfield
To respond to member and provider issues and inquiries. Ensures that callers’ questions and/or problems are resolved or are directed to the appropriate person for resolution and provides the highest level of customer service.
Job ID
2021-2029
FLSA Status
Non-Exempt
Job Locations US-CA-Fairfield
Implements PHC Communications strategies through impactful community relations, member engagement, digital engagement media relations, legislative affairs, branding, and communications with other PHC stakeholders.
Job ID
2021-2026
FLSA Status
Exempt
Job Locations US-CA-Fairfield
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.
Job ID
2021-2024
FLSA Status
Non-Exempt
Job Locations US-CA-Fairfield | US-CA-Redding
Represents PHC in the Grievance & Appeals Resolution process. Responsible for reviewing, investigating, and resolving assigned member grievance and appeal cases ranging from low to high complexity. Works to transform member dissatisfaction into member satisfaction. Oversees the investigative process ensuring casework complies with DHCS guidelines, NCQA standards, and PHC best practices. Works independently, provides leadership on each investigation, prioritizes case deliverables, remains customer-focused, and stays current on changes in the healthcare system that may trigger member dissatisfaction.
Job ID
2021-2023
FLSA Status
Exempt
Job Locations US-CA-Redding
To plan, organize, manage, and implement projects.
Job ID
2021-2021
FLSA Status
Non-Exempt
Job Locations US-CA-Fairfield
Provides advice and counsel to operational departments. As requested,coordinates certain outside legal counsel and oversees outside counsel contracts.
Job ID
2021-2018
FLSA Status
Exempt
Job Locations US-CA-Redding
To begin Treatment Authorization Requests (TAR) reviews and perform data entry upon TAR determination by pharmacy staff. Performs eligibility and benefit investigations. Supports pharmacy department with extracting and collecting data for reporting needs. Supports department's administrative needs, and participates in special projects as assigned by pharmacy technician lead, supervisor, and departmental staff.
Job ID
2021-2016
FLSA Status
Non-Exempt
Job Locations US-CA-Fairfield
Identify member non-medical needs and provide psychosocial case management for assigned demographic (i.e., adults or pediatric population). The Social Worker provides members and/or their families with the supports needed to cope with chronic, acute and/or terminal illnesses, often complicated by other social/environmental or historical factors. The SW provides services including but not limited to: - Identification of available public and private resources - Education regarding systems of care - Coordination of care across agencies, the care continuum, and life stages - Education regarding public and private benefits
Job ID
2021-2015
FLSA Status
Non-Exempt
Job Locations US-CA-Fairfield
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.
Job ID
2021-2014
FLSA Status
Exempt
Job Locations US-CA-Fairfield
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.
Job ID
2021-2013
FLSA Status
Non-Exempt
Job Locations US-CA-Fairfield
To gather and validate healthcare practitioner credentialing information in accordance with regulatory and accreditation standards. Interacts with practitioners by phone to ensure timely receipt of information. Responds to inquiries via telephone and email.
Job ID
2021-2012
FLSA Status
Non-Exempt
Job Locations US-CA-Fairfield
Oversees the day-to-day recruitment and selection of qualified candidates for Partnership HealthPlan of California (PHC). Partners with management to effectively address recruiting needs in a timely manner. Professionally represents PHC in frequent interactions with applicants, all levels of staff, and the public. Provides leadership, support, and training to assigned staff.
Job ID
2021-2011
FLSA Status
Exempt