To design, develop, and test client server and web applications at PHC. To work with the Director, Web Applications Development in the design, development, testing, and deployment of web and desktop applications. Works closely with IT staff in developing applications in business needs supporting AMISYS Advance and networked systems. Assumes senior role in developing applications and supporting existing applications and other applications, as appropriate.

Responsible for the development of all processes necessary to complete SDLC phases of the Web Applications and Automation projects. This includes understanding of business processes, source identification, process design, data collection, data transformation, normalization, error detection and correction, data storage, data linage management, data achieving, and ETL Process oversight for web applications.

The Data Integration Developer is responsible for designing, developing, and maintaining data integration solutions with a focus on EDI (Electronic Data Interchange) for healthcare applications. This role involves implementing ETL processes, managing data pipelines, ensuring data quality, and generating reports to support business intelligence and compliance with

The Compliance Investigator II has demonstrated competencies in supporting the plan-wide regulatory affairs and compliance program, including activities related to HIPAA, Fraud, Waste, and Abuse (FWA), and compliance issues. As such, conducts investigations to effectively prevent, detect, and mitigate healthcare FWA, privacy and compliance issues. Supports daily operations of the Regulatory Affairs & Compliance unit by ensuring deliverables and all case management performance metrics are met for assigned cases. This position serves as an investigative liaison between the plan and our regulatory agencies and internal departments. 

To begin Treatment Authorization Requests (TAR) reviews and perform data entry upon TAR receipt or 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.

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.

The Senior Healthcare Data Analyst I contributes to the overall success of the organization by developing analytic solutions that support activities related to health services utilization management, care coordination, quality improvement and population health. Through analyzing patient claims, member enrollment, and other data, the Senior Healthcare Data Analyst

The Senior Healthcare Data Analyst I contributes to the overall success of the organization by developing analytic solutions that support activities related to health services utilization management, care coordination, quality improvement and population health. Through analyzing patient claims, member enrollment, and other data, the Senior Healthcare Data Analyst

To support in the planning, organization, management, and implementation of projects.

To design, develop, and test data transformations processes and related process automation at PHC.  To work with the Manager of Web Application Development in the design, development, testing, maintaining and migrating the databases and its related processes. Works closely with web Development team to maintain databases and its documentation. 

The Medicare Operations Analyst is responsible for ensuring operational excellence across delegated entities during implementation and post Go-Live implementation for Medicare DSNP program. In collaboration with the respective department, this role oversees implementation and post-implementation day-to-day operations including enrollment, claims processing, utilization/case management (UM/CM), and call center performance. The Analyst will monitor, audit, and collaborate with delegated partners to ensure adherence to CMS regulations, organizational policies, and contractual requirements. Review daily/weekly/monthly operational reports.

This position manages, configures, and maintains Partnership’s HR systems, such as the learning management system (LMS), performance management system, health and wellness system, external content providers, and the employee engagement system. This individual will ensure that all managed systems will meet all regulatory compliance needs and verify data accuracy and

To design, develop, and test client server and web applications at PHC. To work with the Director of Web Applications Development in the design, development, testing, and deployment of web and desktop applications. Works closely with IT staff in developing applications for business needs supporting AMISYS Advance and networked systems. The Senior Web Applications Developer is responsible for designing, developing, testing, and supporting Web Applications.

Oversees the organizational and technical support for the data warehouse. Accountable for the delivery and maintenance of the data warehouse architecture and business intelligence framework that meets the short and long term goals of Partnership.

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.

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

Under the direction of the Cost Avoidance Supervisor, the Cost Avoidance Specialist I 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 interfaces with all departments in an information sharing capacity to promote proper payment procedures and timely cost effectiveness in claims payments.

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

Under direction from the Director of Utilization Management, manages and provides direction to the Health Services department Managers for all product lines ensuring consistent development, implementation, and maintenance of health services programs and achievement of department goals and objectives, in a fast paced, ambiguous environment. Ensures compliance with established criteria and Partnership benefits.