Supervise the day-to-day operations of Partnership HealthPlan of California’s (Partnership) 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 the direction of the Supervisor of Instructional Design, this position: designs and develops innovative and engaging eLearning courses; administers training courses to Partnership HealthPlan of California staff; and performs other duties as assigned.

Under the direction of the CIO, the Director of IT Business Systems will be responsible for overseeing the end-to-end intake, evaluation, and formalization of new technology initiatives, including software requests, solution proposals, IT evaluation of licensing agreements, and software-related contracts. This position will serve as the critical liaison between business units

Works closely with business users and the IT Business Systems Management Team to conduct thorough analyses of project initiatives, contributing to the creation of comprehensive documentation for the preliminary stages of project development. This includes identifying stakeholders, documenting project initiation details, writing business requirements/user stories,

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.

To support the Claims Department in maintaining pended claims and claim adjustments within established guidelines. Reviews and processes complex claims, and supports claims examining.

To design, produce, and analyze Claims Department operational data in support of department objectives and goals. To provide organizational and technical support for the analysis, design, configuration, and documentation of Partnership’s computer systems, and technical and problem resolution support to the systems user community. Utilize knowledge of numerous applications,

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.

Represents Partnership 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,

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 respond to member and provider inquiries regarding case management telephonically. Ensures that callers’ questions and/or problems are resolved or are directed to the appropriate person for resolution and/or entered as a referral for case management while providing the highest level of customer service.

To respond to member and provider inquiries regarding case management telephonically. Ensures that callers’ questions and/or problems are resolved or are directed to the appropriate person for resolution and/or entered as a referral for case management while providing the highest level of customer service.

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

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 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.

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

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 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). 

To plan, organize, manage, and implement projects.