Under direction of the Facilities Supervisor or above, this position will assist with the coordination of the maintenance and repair of the building, including electrical, carpentry, pest control, and scheduling of other repairs as needed. This position will receive instruction and assistance in new and unusual situations and on PHC’s policies and procedures. The duties and

To support new and ongoing, training and staff support needs within the Care Coordination department, and to collaborate with other department leaders to support departmental referral volumes, caseload distributions, systems and operational workflows.

To support new and ongoing, training and staff support needs within the Care Coordination department, and to collaborate with other department leaders to support departmental referral volumes, caseload distributions, systems and operational workflows.

To plan, organize, manage, and implement projects.

Supervise the day-to-day operations of Partnership HealthPlan of California’s (PHC) credentialing functions. Provide leadership, support, training, and direction to the Provider Relations Credentialing Specialist staff. Ensure the highest level of accuracy and timeliness of credentialing functions, including delegation oversight.  Train and monitor staff in the delivery of excellent customer service.

Under direction from the Director of Care Coordination, manages and provides direction to the Care Coordination (CC) Department’s Clinical Integration Team’s Managers, Supervisors, and Individual contributors. A key component of this position is the enhancement and refinement of existing programs, and enthusiastic innovation in the development, management, integration, and refinement of new and existing programs. The Associate Director of Clinical Integration identifies and communicates opportunities aligned with strategic initiatives, market, stakeholder, and regulatory needs. This position is a critical intersection of identification and intake of clinical, regulatory, and business needs from internal and external...

Under the direction of the Associate Director of Internal Audit or above, the Cost Avoidance Manager is responsible for building, leading, and managing the HealthPlan’s Cost Avoidance and Recovery Teams. The purpose of the Cost Avoidance Team is to monitor payment of claims. The purpose of the Recovery Team is to identify overpayments for recovery; research and post provider refund checks, monitor receivables in the Core System; identify, verify, and update Core System with members’ other health insurance coverage information as required.

Represents PHC in the Grievance & Appeals Resolution process. Responsible for reviewing, investigating, and resolving assigned member grievance and appeal cases ranging from low to high complexity. Works to transform member dissatisfaction into member satisfaction. Oversees the investigative process ensuring casework complies with DHCS guidelines, NCQA standards, and PHC best practices. Works independently, provides leadership on each investigation, prioritizes case deliverables, remains customer-focused, and stays current on changes in the healthcare system that may trigger member dissatisfaction.

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

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.

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.

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 governance.

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

This position designs, develops, presents, and/or facilitates innovative and engaging organization-wide Instructor-Led Trainings (ILT), video trainings, and other trainings as requested. Works with department Subject Matter Experts (SMEs) on designing and/or standardizing targeted trainings (i.e. – department specific or audience specific trainings) as requested.

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 Human Resource (HR) Analyst will collect, compile, and analyze HR data, metrics, andstatistics, and apply this data to assist HR leadership in developing strategic solutions and data driven decisions. Applies best practice data analytic skills to guide decision-making, process improvement and a desire to bring analytical solutions to organization's HR strategies. Supports the organization's overall ability to use Human Resource data in decision making to drive improved outcomes by supporting key initiatives with data analysis and insight...

To assist in the day-to-day operations and management of the Member Services Department. Provides leadership and support and direction to Member Services staff.

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

Train examiner and customer service level I staff on all related claim types for all PHC lines of business using AMISYS Advance system and Claims Operating Instruction Memorandums.