To design, support, and provide strategic planning of the Business Intelligence solution across the enterprise. Manages deployment, maintenance, and support of Business Intelligence tools and reports. Analyzes, creates, documents, tests, maintains, troubleshoots, and promotes the Business Intelligence environment.

Provides a range of social work services as a county child welfare liaison in collaboration with Partnership staff to meet the psycho-social and care coordination needs of members involved in the child welfare system. Responsible for the assessment and care coordination of the psychosocial needs of these 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.

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.

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

To develop provider and member educational opportunities for internal departments, external agencies, training, and materials to support PHC providers, community partners, and members. Provides hands-on support to internal team as well as to PHC providers, community partners, and members.

The IT Operations Manager oversees the administration and management of the PHC network infrastructure, server functionality, and telecommunication (VoIP) systems. The IT Operations Manager is required to manage, prioritize, and coordinate workloads and efforts across IT network operations. In collaboration with the Director of Network Operations, the IT Operations Manager provides training to the IT Operations staff on key areas of network, server management, and VoIP systems so they can act as a backup in an emergency.   The IT Operations Manager is responsible for establishing, prioritizing, and supervising varied tasks as it applies to the network infrastructure, servers,...

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.

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...

Implements Partnership HealthPlan of California (PHC) communications strategies through impactful member engagement, digital engagement, media relations, legislative affairs, community relations, branding, and communications with PHC stakeholders.

To provide coordination and implementation support of defined tasks for the assigned program(s).

The EDI Application Administrator is responsible for the installation, configuration, maintenance, and support of EDI software applications within the organization. This role ensures the optimal performance, availability, and security of applications to meet business needs and user requirements.

The Manager of IT Change Control at Partnership HealthPlan of California (Partnership) plays a critical role in managing and improving the IT change management processes. The role ensures that changes to IT systems, infrastructure, and applications are implemented in a controlled, compliant, and efficient manner to minimize risks and service disruptions to Partnership’s business operations. The Manager of IT Change Control collaborates closely with multiple departments, including IT, security, clinical operations, and external vendors, to ensure changes align with Partnership’s business priorities, regulatory requirements, and industry standards. This role is pivotal in supporting continuous improvement efforts in IT...

To respond to member and provider inquiries regarding case management telephonically. Ensures that callers’ questions and/or problems are resolved or are directed to the appropriate person for resolution and/or entered as a referral for case management while providing the highest level of customer service.

To respond to member and provider inquiries regarding case management telephonically. Ensures that callers’ questions and/or problems are resolved or are directed to the appropriate person for resolution and/or entered as a referral for case management while providing the highest level of customer service.