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.

Under the direction of the Deputy Chief Operating Officer, this position is responsible for representing PHC in the assigned region. This includes strategic planning, implementation of programs or benefits, and developing relationships in the health care delivery system of each community served by the regional office. Oversees the day-to-day operations of PHC’s Regional Office and Regional Office staff; acting as PHC’s Regional community liaison with PHC’s stakeholders.

Under the direction of the Deputy Chief Operating Officer, this position is responsible for representing PHC in the assigned region. This includes strategic planning, implementation of programs or benefits, and developing relationships in the health care delivery system of each community served by the regional office. Oversees the day-to-day operations of PHC’s Regional Office and Regional Office staff; acting as PHC’s Regional community liaison with PHC’s stakeholders.

To direct and plan selection and execution of system configuration development and manage daily activities of healthcare related configuration development efforts. Define and implement policies and procedures to achieve integration of various system related configuration. Ensures the accuracy and completeness of assigned projects and programs per PHC and State of California Medi-Cal guidelines and department guidelines. Develops and executes program improvements aligned with strategic priorities. To provide overall project support for planning, implementation, testing, and coordination of configuration related projects. Develops, reports and presents information to all...

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.   ***This position requires the individual to work at least one weekend per...

To analyze and interpret financial data and procedures to prepare financial information and reports. Applies generally accepted accounting principles and procedures (GAAP) to record, classify, and examine financial transactions. Participates in Month End Close responsibilities such as journal entry creation to book expenses and accruals, uploads these items to accounting system and reconciling sub ledger accounts. Participates in annual financial audit by preparing requested audit schedules and responding to ad hoc audit requests. Responds to customer base (i.e. employees, outside vendors, members) in a timely and professional manner

To provide daily supervision of utilization management staff. Provide departmental leadership, support, resources and direction to staff. Assists in developing and maintaining a cohesive team with a high level of productivity, accuracy and quality to achieve departmental goals and objectives.

The Sr. Director of Information Security reports to the Chief Information Officer and maintains a strong relationship with Infrastructure Technology (Network Ops), IT Applications Development, IT Enterprise Data Management, and the functional departments of Partnership HealthPlan of California (Partnership). The Sr. Director is responsible for building and leading a team of Cyber Defense Operation Center (CDOC) colleagues. This position will work with various Managed Security Service Providers (MSSP) to establish and maintain threat escalation and remediation protocols including off hours. This role is to direct and manage all aspects of running an efficient team including hiring, supervising, coaching, training, disciplining, and motivating direct-reports. The Sr....

To manage and coordinate incoming grievances and appeals and provide administrative support for the Grievance Unit. Assesses and completes appropriate documentation for tracking and trending date, which may include conducting all pertinent research on a level one grievance in accordance with all established regulatory guidelines. Reviews delegated grievance logs and processes requests for grievance data and reporting.

In collaboration with departmental and organizational leadership, supports the organization’s Population Needs Assessment activities through active and meaningful engagement in identified community workgroup and initiatives. On behalf of the health plan identifies and supports, key strategic activities and interventions that support alignment of collective agency efforts that promote and support efforts to encourage member health outcomes.

Design, develop, and document PHC’s core software applications and provide technical and problem resolution support to the IT department and the users.

To assist in the improvement of PHC’s Health Services business processes and systems through the identification, analysis, and recommend actions for improvement. Provides systems support of operating and business goals of the health plan as a whole. This position collaborates with the Finance, Information Technology (IT) and Data Warehouse (DW) teams to develop and support organization-wide reporting. The incumbent participates in gathering and documenting report requirements. Responsible for designing, building and administering reporting solutions for requesting departments. Assists departmental Business/Data Analysts in developing reports using the available Business Intelligence (BI)...

The Accountant II-Cash Management (Accounts Receivable) position will be a key member of the cash management team and is responsible for various cash and invoicing functions, including the invoicing and posting of cash receipts for Leased Tenants, Wellness and Recovery Drug Medi-Cal Counties and other entities as required. This position will be the main point of contact for inquiries related to such invoices.   This position will possess excellent communication skills as they will not only respond to billing inquiries but will also manage the Cash Management Helpdesk and address inquiries on a timely basis.

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.

Under the general direction of the Associate Director of Health Analytics, this position is responsible for managing the Health Analytics Team at PHC. The goal of the Health Analytics Team is to help PHC improve the health of our members and the communities we serve by developing and producing high quality analytic reports of health care data for use internally and externally. To achieve this, the Manager of Health Analytics will manage, mentor, and train a group of highly motivated and highly qualified health analysts, working collaboratively with the Data Warehouse Team and the Financial Analysis Team. Collectively these three units (Health Analytics, Financial Analysis, and Data Warehouse) provide the analyst workforce and...

The Sr. Manager of HRP Transaction Management will oversee and manage HRP Transaction Management functions effectively. This entails leading a team, prioritizing tasks, establishing and enforcing standards, training staff, testing and implementing new code, analyzing user requirements, and aligning work with business priorities.

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.

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 design, install, configure, implement, and support all aspects of infrastructure environments, providing technical guidance and oversight and acts as a point of escalation and technical support. Responsible for server farms’ uptime, production maintenance, roll-out of new servers, and other critical deployments. Responsible for assisting in the support of PHC’s server applications, web servers, database servers, fax server, VOIP infrastructure, UNIX/Amisys systems environment, Pure storage array based SAN environment and other application servers, as determined by the Director of Network Operations. Assist senior team members with network, related hardware devices, and other...

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.