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.

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.

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.

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 develops forms and presentations.

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. 

Partnership HealthPlan of California is the pre-eminent rural health plan in California, serving 24 Northern California counties. The Government Affairs team is responsible for Partnership’s engagement with local, state, federal stakeholders, including with key legislator, regulators, and others. The Associate Director of Government Affairs will serve as a key member of Partnership’s Government Affairs team leading advocacy, relationship development, and issue management for Medi-Cal and Medicare related policy. Using multiple engagement tools, the Associate Director of Government Affairs will advocate for rural health care needs, sharing Partnership’s perspectives at the statewide level to inform rural Medi-Cal...

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...

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 plan, organize, manage, and implement projects.

Under the direction of Grievance Supervisor, the Grievance and Appeals Associate is responsible for monitoring all incoming cases, recording them in Everest, and assigning new cases to the appropriate Grievance Staff.   Provides clerical support to Grievance Staff by ensuring all correspondence is printed and mailed timely, according to DHCS timeframes and HIPAA confidentially laws.  Responsibilities also include accepting incoming calls on the ACD phone system, assisting customers.  Performs other administrative and/or clerical support to the department and/or management as needed.

Provide a range of social work services in collaboration with PHC 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.

Responsible for the delivery of business intelligence solutions across the enterprise. Manages deployment, maintenance, and support of data access tools and reports.

To serve as first level production support for conference rooms, desktops, phones, printing, software and other computer related operations.  Analyzes, investigates, and resolves reported issues. Determines underlying sources for problems and escalates issues to next level of support if necessary.

To be responsible for managing the community engagement with our specific communities that are experiencing health disparities in 24 counties and improving key disparities found with CAHPS score. Establishes connections with various community-based organizations and translates their needs to tangible actions that the health plan can act upon. Advises on Partnership’s community engagement across multiple departments. Leads engagement with network providers, subcontractors, downstream subcontractors to implement focus groups or individual 1:1 meetings, across the network, to directly gather direct feedback from members. The position will lead a team of specific community health needs liaisons that are specific to health...

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.

In collaboration with the HR Recruiters coordinates the ongoing recruitment and selection of industry experienced and leadership positions for Partnership HealthPlan of California (PHC) by providing assistance and administrative support. Professionally represents PHC in frequent interactions with applicants, all levels of staff, and the public. Holds employee and applicant confidentiality in the highest regard.

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.

Supervise daily operations and provide leadership, support, and direction to assigned Provider Relations Representative staff. Ensure the highest level of customer service is a priority of PR staff. Monitor department goals and meet deadlines. Recruit and retain Provider network.

The Coordinator II will coordinate assigned departmental projects and provide complex administrative support to department leaders. Develops, implements and monitors processes, tools, and systems for collecting, tracking and managing information required for monitoring performance and deadlines. Develops and produces reports. In addition to the Coordinator I duties, the Coordinator II may handle escalated calls, escalated Helpdesk inquiries, and may follow up with providers regarding missing 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 federal regulations, and to fulfill all contractual requirements.