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To provide high-level support for day-to-day PC operations, production operations support, systems and telecommunications support. Support and lead all help desk functions with PC troubleshooting, performing software updates and maintaining the inventory of PC’s and network systems hardware. Serve as the primary and second level escalation point for desktop, VoIP, A/V, and connectivity support to internal customers/ end-users. Supports IT Operations efforts in the building with implementation, testing, and deployment of new servers, and software, systems, network, and security changes. Primary operations support to production environment, maintains necessary skills related to production support, and functions as on call support as required. Learns advanced operations procedures and troubleshooting techniques from Director of Network Operations and documents them.
To provide high-level support for day-to-day PC operations, production operations support, systems and telecommunications support. Support and lead all help desk functions with PC troubleshooting, performing software updates and maintaining the inventory of PC’s and network systems hardware. Serve as the primary and second level escalation point for desktop, VoIP, A/V, and connectivity support to internal customers/ end-users. Supports IT Operations efforts in the building with implementation, testing, and deployment of new servers, and software, systems, network, and security changes. Primary operations support to production environment, maintains necessary skills related to production support, and functions as on call support as required. Learns advanced operations procedures and troubleshooting techniques from Director of Network Operations and documents them.
To research and resolve complex claims issues which cross interdepartmental lines and communicate the outcome to providers and affected PHC managers. Develops and maintains provider training materials for all lines of business. Conducts provider trainings across PHC departmental lines in group or individual provider settings.
To provide administrative support to the executive leader, leadership teams, and staff as assigned. In addition to the Administrative Assistant II duties, the Executive Assistant has a higher level of education and experience and more autonomy, works with a higher level of internal/external customers, serves as liaison to external customers, and a exposed to higher confidentiality.
Under the direction of the Cost Avoidance Supervisor, the Cost Avoidance Specialist I monitors activities related to cost savings and recoveries of medical claim payments; identifies and verifies members other health coverage (OHI), updates system and recovers overpayment, and researches and validates provider refund checks. The Cost Avoidance Specialist interfaces with all departments in an information sharing capacity to promote proper payment procedures and timely cost effectiveness in claims payments.
To effectively communicate and implement project management methodologies required 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. Projects are time bound with a distinct start and end point. Ensure accuracy, consistency, and thoroughness of projects.
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 provide administrative support to the department head, leadership team, and staff as assigned.
The AV Support Specialist will develop and implement solutions that optimize Partnership
HealthPlan’s video collaboration capabilities, while also providing guidance and support to other
team and staff members. This position will be required to troubleshoot and problem-solve
quickly and efficiently. The AV Support Specialist will be an integral part of our IT Operations
team.
To assist in developing and maintaining HIPAA compliant ANSI X12 EDI healthcare transactions for PHC. Responsibilities include programming the federal and/or state mandated transactions and other EDI applications using tools & technologies such as EDI Translators, Microsoft SSIS/SSRS package solutions, Microsoft Transaction SQL blocks and Oracle PL/SQL.
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 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 provide administrative support to the department head, leadership team, and staff as assigned.
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.
Primary duty of the CSR III is to routinely process CIFs. They will be responsible to learn all CIF claim types within 18 months of accepting position.
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.
Provide supervisory oversight during the daily operations of the outpatient review process. Supervise and train assigned team members. Provide leadership, support, resources, and direction to staff. Assist in determining appropriateness, quality, and medical necessity of requested service.
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 assignments.
Under the direction of the Manager of Performance Improvement, the Improvement Advisor is
uniquely positioned to drive improvement across PHC, our provider network, and the communities
we serve. The Improvement Advisor will work internally and externally with provider practices
and community partners to identify, plan, and facilitate quality improvement projects. Via
individualized facilitation, this position will coach and train improvement teams to build team
members’ quality improvement (QI) skills, develop their organizational capacity for QI work, and
help them meet their specific QI goals. In addition to working directly with improvement teams,
the Improvement Advisor will join PHC’s Performance Improvement training team, and will
facilitate workshops and learning collaborative sessions on topics such as improvement
methodology, QI measurement, process improvement, project management, and change
management.
To oversee active project management and deliver successful projects. Sets and follows clear project management standards including project plans, risk registers, and other project management documents. Responsible for the successful delivery of IT projects and assists in developing standards, managing the enterprise IT project priority list, and IT Steering Committee meetings.