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

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.

To review, research, and resolve claims for all Medi-Cal claim types within established production and quality standards, including manual processing. Completes and processes claims and claims worksheets. Creates appropriate documentation that reflects the actions taken and status of the claim. Generates provider communication, such as letters, as necessary. Routes and tracks claims requiring review by other staff and departments, and processes when possible. Claims Examiner II is distinguished from Claims Examiner I by a higher level of autonomy and experience, as well as an ability to process a wider range of claim types.

The Business Telecom Manager is responsible for leading the strategic planning, coordination, and prioritization of telecom-related business initiatives across departments. This role acts as the liaison between business units and the technical telecom team, ensuring that communication solutions align with organizational goals and operational needs. The manager will oversee business requirements gathering, feature tracking, and release planning for VOIP, voicemail, call recording, and other telecom services. This position works in tandem with Information Technology as the business arm to telecom, ensuring that business needs are clearly defined, prioritized, and translated into actionable

The Senior Network Engineer plays a critical role in ensuring the stability, performance, and security of the organization’s network infrastructure. This position is responsible for designing, implementing, and supporting complex network solutions that meet evolving business and operational needs. As an experienced member of the IT Operations Team, the Senior Network Engineer serves as a technical expert and escalation point for network issues. The role involves deep expertise and hands-on work across routing, switching, firewalls, and emerging technologies such as SD-WAN and network automation, and may also serve as a technical lead for a small team of Network Engineers, providing...

This position is responsible for working with Indian Health Services and Tribal Communities in Partnership HealthPlan of California (Partnership) assigned counties. Participates in the design, implementation, and/or expansion of strategic programs and departmental initiatives in relationship to tribal and Indian health services deliverables. Develops and delivers program goals, measures, and reports. The Liaison will be responsible for a range of functions to improve the physical, behavioral and oral health of American...

To accurately perform concurrent, retrospective, and special audits on all level I claim types for all Partnership lines of business.

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 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

To plan, organize, manage, and implement projects.

Under the general direction of the CIO, the Director, IT Strategic Initiatives is responsible for overseeing IT strategic initiatives; developing, implementing, and auditing methodologies and best practices related to steering committees; and prioritization of projects and best practices related to the Systems Development Life Cycle (SDLC). The Director will be responsible for ensuring that there is a consistent development and implementation process and that it is followed. The Director will work with the CIO and other department directors to prioritize projects and provide status reports to the CIO and Steering Committee.

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.

The DSNP Project Manager is responsible for coordinating activities related to the Dual Eligible Special Needs Plan (DSNP) lifecycle. This role ensures compliance with CMS requirements, timely execution of deliverables, and seamless collaboration across internal teams and external partners and will oversee strategic project planning and manage all aspects of AEP operational readiness including all impacted business functions. This position will effectively manage assigned projects, utilizing appropriate project management methodologies to drive the planning, implementation, and tracking of projects through all aspects of the project...

The Housing Services Coordinator is responsible for reviewing, approving, and supporting requests for housing-related services for Community Supports services offered by the health plan. This role ensures that housing related services are appropriate, align with program criteria, and support members stability and health outcomes. The position works closely with departmental clinical teams, care management teams, external

To support the overall financial success of Partnership by providing senior level responsibilities in the preparation and analysis of Generally Accepted Accounting Principles (GAAP) financial statements, statutory financial reports, budget development and internal operational reports.  Position maintains a significant role in the maintenance of the general ledger and the month end close process.  The Senior Accountant is responsible for or assists with the maintenance and configuration of the accounting systems as well as being an advance user.  The Senior Accountant has excellent analytical skills and a thorough knowledge of accounting principles to analyze financial reports...

To direct and coordinate medically necessary behavioral health treatment services for members seeking behavioral health services. Oversees operations of Behavioral Health Call Center and staffing. Oversees staff to ensure the coordination of care for members seeking behavioral health services for both carved in and carved out services. Ensures regulatory compliance with

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. 

To lead the data quality improvement efforts throughout the organization. The Senior Data Quality Analyst uses their in-depth knowledge of the data and its potential quality issues to recognize and resolve data quality issues prior to them becoming data problems. This position provides organizational and technical support for the analysis, improvement and documentation

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

Provide a range of social work services in collaboration with Partnership staff to meet the psycho-social and care coordination needs of members. Responsible for the assessment and care coordination of the psycho-social needs of members, families and/or caregivers to help promote positive coping skills, reduce the risk of premature institutionalization, assist individuals in maintaining independence in the community and increase stabilization of social determinants.