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 or specialty care review. May also carry a caseload of cases requiring telephonic and/or on-site inpatient review at acute or rehab facilities.

To develop, implement, improve, and manage assigned programs. In addition to the Program Manager I duties, the Program Manager II has a higher level of experience, more autonomy, exercises independent judgement, and conducts business analysis and program analytics. Programs are ongoing, which may include aligned projects and requires strategic planning and continuous improvement efforts after program startup. Participates in the design, implementation, and/or expansion of strategic programs and departmental initiatives. Develops and delivers program goals, measures, and reports.

The Member Engagement Specialist serves as a liaison between the organization and the communities that we serve. This role includes project management/coordination and support of various programs and committees including but not limited to: outbound call projects, Consumer Advisory Committee activities, informative presentations, and community events. Additionally, the Member Engagement Specialist supports department leadership in developing, implementing, and sustaining the Member Engagement Program strategies and objective to achieve Partnership’s mission and goals.

To develop, implement, improve, and manage assigned programs. The Program Manager I is responsible for the overall success for the assigned program(s) and their role extends beyond completion of individual tasks.  Programs are ongoing, which may include aligned projects and requires strategic planning and continuous improvement efforts after program startup.  Participates in the design, implementation, and/or expansion of strategic programs and departmental initiatives. Supports the development and execution of program goals, outcome measures, and program reporting.

To plan, organize, manage, and implement projects.

Under the general direction of the CIO, the Director, IT Strategic Initiatives is responsible for overseeing IT strategic initiatives; developing, implementing, and auditing methodologies and best practices related to steering committees; and prioritization of projects and best practices related to the Systems Development Life Cycle (SDLC). The Director will be responsible for ensuring that there is a consistent development and implementation process and that it is followed. The Director will work with the CIO and other department directors to prioritize projects and provide status reports to the CIO and Steering Committee.

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

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)...

To research and resolve complex claims issues which cross interdepartmental lines and communicate the outcome to providers and affected PHC managers. D

To provide coordination and implementation support of defined tasks for the assigned program(s). In addition to the Program Coordinator I duties, the Program Coordinator II has a higher level of experience, conducts business analysis to evaluate programs, tracks and reports data to a higher complexity level, coordinates daily activities, communicates program status to stakeholders, and confirms that outcomes are meeting program requirements.

To effectively lead assigned projects, utilizing appropriate project management methodologies 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. In addition to the Project Manager II duties, the Senior Project Manager is a leadership role that provides coaching and guidance to less experienced project managers, has a higher level of education and/or experience, is expected to work autonomously, and exercises independent judgment. This role may have assigned direct report(s). 

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.

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

To plan, organize, manage, and implement projects.

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,...

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 support the overall financial success of PHC by providing senior level responsibilities in the preparation and analysis of Generally Accepted Accounting Principles (GAAP) financial statements, statutory financial reports, budget development and internal operational reports.  Position maintains a significant role in the maintenance of the general ledger and the month end close process.  The Senior Accountant is responsible for or assists with the maintenance and configuration of the accounting systems as well as being an advance user.  The Senior Accountant has excellent analytical skills and a thorough knowledge of accounting principles to analyze financial reports and...

Responsible for the delivery of business intelligence solutions across the enterprise. Manages deployment, maintenance, and support of data access tools and reports.