To plan, organize, manage, and implement projects.

To assist in the improvement of PHC’s Health Services business processes and systems through the identification, analysis, and recommend actions for improvement. Provides systems support of operating and business goals of the health plan as a whole. This position collaborates with the Finance, Information Technology (IT) and Data Warehouse (DW) teams to develop and support organization-wide reporting. The incumbent participates in gathering and documenting report requirements. Responsible for designing, building and administering reporting solutions for requesting departments. Assists departmental Business/Data Analysts in developing reports using the available Business Intelligence (BI)...

To research and resolve complex claims issues which cross interdepartmental lines and communicate the outcome to providers and affected PHC managers. D

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.

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 manage daily operations of the Provider Relations department including personnel and operational responsibilities. Ensure PR department is compliant with regulatory requirements and network reporting. Coordinate NCQA activities with QI department. Primary liaison with Northern Region office staff.

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 effectively lead assigned projects, utilizing appropriate project management methodologies to drive the planning, implementation, and tracking of projects through all aspects of the project lifecycle. Project Managers are responsible for the planning, procurement, and execution of a project. In addition to the Project Manager II duties, the Senior Project Manager is a leadership role that provides coaching and guidance to less experienced project managers, has a higher level of education and/or experience, is expected to work autonomously, and exercises independent judgment. This role may have assigned direct report(s). 

The compliance analyst for the Grievance & Appeals (G&A) department plays a key support role in ensuring the department maintains compliance with regulatory, accreditation, and internal standards. Under the direction of the G&A Compliance Manager, this role is responsible for assisting with policy and the procedure maintenance, audit preparation and support, and oversight of delegated entities. The compliance analyst also plays a critical role in identifying process and quality improvement opportunities through data analysis and trending of grievance and appeal cases. This is a dynamic and multifaceted position that supports various compliance activities to maintain organizational readiness for internal audits,...

To provide organizational and technical support for the analysis, design, configuration, and documentation of PHC’s computer systems, and technical and problem resolution support to the systems user community. The Senior IT Business Analyst addresses complex systems issues and may work with technical leads and business users to resolve issues; works with business users to gather requirements and recommends a solution, including new systems and functionality; may provide training to business users and IT personnel; and provides coaching and guidance to IT Business Analysts. This position may function independently and applies depth of experience gained from previous successful...

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 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

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 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.