Job Listings

To provide daily oversight, leadership, support, training and direction of both clinical and non-clinical staff. Supports and assists the Team Manager in developing and maintaining a cohesive team with a high level of productivity and accuracy to achieve the department's overall performance metrics. Designs and implements high quality, cost-effective care plans to enable members to achieve health goals.

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) tools. Will develop ad-hoc reports for business users as applicable. Participates in the design and development of the reporting infrastructure using SQL Server technologies and BI reporting tools (Tableau, SAS, Business Objects).  

Design, develop, and document PHC’s core software applications and provide technical and problem resolution support to the IT department and the users.

The Manager of UM Operations is responsible for the operational aspects of Utilization Management, including responsibility for providing daily oversight, leadership, support, and management of assigned staff. Ensures compliance with established criteria, regulations, standards, best practices and Health Plan benefits, in a fast-paced and ambiguous environment.

The Manager of Utilization Management (UM) will provide leadership and clinical oversight for operational aspects of UM, including the responsibility for providing daily oversight, leadership, support and management of assigned staff. 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.

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 quality and cost-effective outcomes.   In addition to the Care Coordination Case Manager I duties, the Care Coordination Case Manager II has a higher level of experience, evaluates special requests, assists benefit interpretation, serves as a liaison between the line staff and the supervisor, participates in audit activities and shows initiative improving processes.

To provide coordination and administrative support to department managers. Performs a variety of general clerical duties, including data entry, report generation, and develops forms and presentations.

To provide coordination and administrative support to department managers. Performs a variety of general clerical duties, including data entry, report generation, and develops forms and presentations.

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 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.

The Enrollment Specialist I will assist in maintaining Medi-Cal membership and process basic functions of the Enrollment Unit. This position will review, research, and resolve Medi-Cal eligibility issues and systems related errors as well as primary care physician (PCP) assignment failures within established production and quality standards. Completes and processes reports and appropriately documents member records of actions taken to correct or update member records, PCP assignments etc. Processes reports to ensure primary care assignment is appropriate, processes certain authorized representative forms and document members records appropriately. Reports eligibility discrepancies and deceased members to appropriate counties and adds newborn records upon request and after verification of eligibility.

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.