Under the general supervision of department leadership, the Quality and Training Supervisor will lead the design and structure of the department’s Quality Assurance (QA) and training program. Responsibilities include: designing, developing, implementing, and managing all quality and training activities for the department. Additionally, the supervisor is responsible for driving the attainment of quality metrics and to achieve superior results. Through demonstrated individual performance, the Quality and Training Supervisor shall promote the highest standards of ethical and professional conduct to lead staff members by example.

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.

To establish and maintain excellent relationships with the provider network in a specific geographic region, including healthcare practitioners, office staff, and administrators. Works closely to identify and resolve complex issues, provides education and staff training. Provides service and education via onsite visits and telephone. Assists providers with understanding Partnership HealthPlan of California's policies and procedures and assists with resolving issues that arise.

To provide administrative support to the department head, leadership team, and staff as assigned.

To establish and maintain excellent relationships with the provider network in a specific geographic region, including healthcare practitioners, office staff, and administrators. Works closely to identify and resolve complex issues, provides education and staff training. Provides service and education via onsite visits and telephone. Assists providers with understanding Partnership HealthPlan of California's policies and procedures and assists with resolving issues that arise.

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 plan, organize, manage, and implement projects.

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. 

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. Works collaboratively with departments company-wide to identify data needs, develop and maintain data queries and tools, and complete accurate...

To support and/or lead in planning, organization, management, and implementation of projects. In addition to the Project Coordinator I duties, a Project Coordinator II has a higher level of experience, works well with ambiguity and is expected to work with more autonomy on assignments 

Under the direction of the Cost Avoidance Manager, the Cost Avoidance Specialist II monitors activities related to cost savings and recoveries of medical claim payments; identifies and verifies members’ other health coverage (OHI), updates system and recovers overpayment, and researches and validates provider refund checks. The Cost Avoidance Specialist II interfaces with all departments in an information sharing capacity to promote proper payment procedures and timely cost effectiveness in claims payments.

To plan, organize, manage, and implement projects.

To maintain accurate provider information by entering necessary data elements into several database systems. Works closely with team members and other departments to research and resolve routine and complex issues and inquiries related to provider data. In addition to the Provider Systems Data Specialist I duties, the Provider Systems Data Specialist II has a higher level of experience, more autonomy, and more complex assignments.

To design, install, configure, implement, and support all aspects of infrastructure environments, providing technical guidance and oversight and acts as a point of escalation and technical support. Responsible for server farms’ uptime, production maintenance, roll-out of new servers, and other critical deployments. Responsible for assisting in the support of PHC’s server applications, web servers, database servers, fax server, VOIP infrastructure, UNIX/Amisys systems environment, Pure storage array based SAN environment and other application servers, as determined by the Director of Network Operations. Assist senior team members with network, related hardware devices, and other...

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.

To provide high-level support for day-to-day PC operations, production operations support, systems and telecommunications support. Support and lead all help desk functions with PC troubleshooting, performing software updates and maintaining the inventory of PC’s and network systems hardware. Serve as the primary and second level escalation point for desktop, VoIP, A/V, and connectivity support to internal customers/ end-users. Supports IT Operations efforts in the building with implementation, testing, and deployment of new servers, and software, systems, network, and security changes. Primary operations support to production environment, maintains necessary skills related to production...

This position is responsible for coordinating PR projects, developing, implementing, and monitoring inventory or other operational processes, tools, and systems required for collecting, tracking, and managing information for staff performance, regulatory reports and audits. Works closely with management and staff to ensure deadlines are met and provides routine and complex administrative support for the department.

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...

To plan, organize, manage, and implement projects.

To establish and maintain excellent relationships with the provider network in a specific geographic region, including healthcare practitioners, office staff, and administrators. Works closely to identify and resolve complex issues, provides education and staff training. Provides service and education via onsite visits and telephone. Assists providers with understanding Partnership HealthPlan of California's policies and procedures and assists with resolving issues that arise.