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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 administrative support to the executive leader, leadership teams, and staff as assigned. In addition to the Administrative Assistant II duties, the Executive Assistant has a higher level of education and experience and more autonomy, works with a higher level of internal/external customers, serves as liaison to external customers, and a exposed to higher confidentiality.
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.
This position provides support and guidance to Partnership HealthPlan of California (PHC) members for wellness services and incentive programs in a call-center environment. The Wellness Guide works closely with members and their families to encourage members to engage in healthy activities (including preventative care visits and chronic care management), remind members of available benefits, and connect members to available internal and external resources.
To provide Basic Population Health Management services for members which includes engaging
with members individually or as part of a group to support lifestyle modifications to manage
chronic diseases, to identify care gaps and needed services, and to aid Partnership members in
maintaining wellness. Healthy Living Coaches shall also serve as a resource about Partnership
member benefits as well as Population Health programs and services.
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
participates in identifying progress, performance and opportunities for improvement on
programs, quality of care, patient experience, and other metrics. This position requires a
thorough understanding of healthcare data and workflows, combined with an extensive
experience working with large data sets, conducting data analysis, including standard statistical
software (SAS), and creating reports using Tableau.
To effectively communicate and implement project management methodologies required 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. Projects are time bound with a distinct start and end point. Ensure accuracy, consistency, and thoroughness of projects.
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.
This position is responsible for being the primary lead for research and resolution of complex
provider data issues. Extracts, manipulates, analyzes, and evaluates accuracy of provider data for
regulatory reporting and new program implementations and ensures compliance with state and
federal regulatory requirements. Trains or facilitates training for learning how to use PR’s
provider data system, reconciling discrepancies, preparing regulatory and internal reports and
understanding the provider network. Serves as the provider data steward assisting the
Information Technology department and others in defining report specifications and building
programs. Oversees and/or completes projects with high complexity and assists other staff with
day-to-day operational activities. Coordinates and/or completes projects with medium to high
complexity. Participates in complex interdepartmental initiatives.
To plan, organize, manage, and implement projects.
To provide administrative support to the department head, leadership team, and staff as assigned.
The AV Support Specialist will develop and implement solutions that optimize Partnership
HealthPlan’s video collaboration capabilities, while also providing guidance and support to other
team and staff members. This position will be required to troubleshoot and problem-solve
quickly and efficiently. The AV Support Specialist will be an integral part of our IT Operations
team.
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 assist in developing and maintaining HIPAA compliant ANSI X12 EDI healthcare transactions for PHC. Responsibilities include programming the federal and/or state mandated transactions and other EDI applications using tools & technologies such as EDI Translators, Microsoft SSIS/SSRS package solutions, Microsoft Transaction SQL blocks and Oracle PL/SQL.
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 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.
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.
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 assist with planning, implementing, and analyzing cultural and linguistic health education (C&LHE) services for PHC staff, Providers, and Members. Participates in state level C&LHE committee meetings and implementing work plans to meet regulatory requirements.
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.