To work with a dedicated and committed team, the RN Quality Investigator I is responsible for assessing and improving the quality of care provided by the providers serving our members.

To assist and support the Director with development, implementation, and maintenance of professional, facility, and ancillary contracts for the Partnership provider network. The Contracts Coordinator II is responsible for, Contracting Department tracking, and reporting provider network activities, including of scanning contract documents, mailing or emailing network notices related

To work with a dedicated and committed team, the site review inspections team, to oversee and implement Site Reviews, provide education to provider sites and to assess and improve the quality of care delivered by providers. Types of providers reviewed include, but not limited to, Primary Care Physicians, Obstetrics, Palliative Care and Private Duty Nursing.

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 daily oversight, leadership, support, training and direction of nonclinical staff. Supports and assists the Team Manager and other Case Management Supervisors in developing and maintaining a cohesive team with a high level of productivity and accuracy to achieve the department's overall performance metrics.

The Mental Health Manager is responsible for the management of mental health services, which includes multiple work groups of significant depth and complexity. Responsibilities include overall management of this service area, including working with the Behavioral Health Administrator for the development of the service areas objectives and design and implementation of supporting and expansion programs, processes, policies, and/or procedures to successfully achieve those objectives.

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.

The G&A Nurse Supervisor provides clinical and operational supervision to the Grievance & Appeals nursing team, including Nurse Specialists, Sr. Nurse Specialists, and State Hearing Representatives. The Nurse Supervisor maintains an active clinical caseload while overseeing the daily operations, workload distribution, and performance of the clinical team. The Nurse

To respond to member and provider calls regarding Plan policies, procedures, membership, eligibility, benefits, and claims, providing the highest level of customer service. In addition to the Member Services Representative duties, the Lead Member Services Representative has a higher level of experience, monitors call queues, assists with training material, and handles complex calls that cannot be resolved by the Member Services Representatives.

This position will assist in the management of hardware, software and licensing. Additionally they will work to ensure all procedures are followed in the purchasing of hardware, software and licenses. The person in this position will analyze system data, prepare purchase orders, solicit bid proposals and review requisitions. This position will ensure all IT purchases are completed in a timely manner, in compliance with current Partnership HealthPlan of California (PHC) purchasing and contracting policies, and in alignment with IT and PHC strategic plan. This position will also work with the Chief Information Officer (CIO) and/or designee in the review

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 develops forms and presentations.

To lead and participate in the development of complex software systems and programs at Partnership. Collaborates with the IT Director in the analysis, design, programming utilizing specifications and applying programming standards, troubleshooting, problem resolution, maintenance, and documentation of software systems and programs. Oversees all aspects of

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.

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.

To provide administrative support to the department head, leadership teams, and staff as assigned. In addition to the Administrative Assistant I duties, the Administrative Assistant II has a higher level of experience and more autonomy, is involved in project coordination, identifies necessary efficiencies, and is exposed to confidential information.

To assist in the negotiation, development, implementation, and maintenance of new and existing professional, facility, and ancillary contracts for the PHC provider network. The Contract Specialist will also be responsible for supporting daily contracting activities as follows:

The Senior Director of Quality and Performance Improvement is a key individual on PHC’s Senior Leadership Team and is responsible for leading a growing Quality Department at Partnership HealthPlan of California (PHC) through quality and performance improvement activities to substantially improve the quality of care provided to PHC members.

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.

Responsible for the development of all processes necessary to complete all phases of the Enterprise Data Warehouse (EDW). This includes source identification, data collection, data transformation, normalization, rule administration, error detection and correction, data consolidation, data storage, data distribution, schema mapping, data enrichment, and data