Under the leadership of the Director of Population Health, manages and provides direction to the  Population Health team managers and supervisors to ensure Basic Population Health Management  activities are performed in compliance with DHCS and NCQA requirements. Participates in the  development, implementation, and maintenance of Population Health programs and achievement  of department goals and objectives in a fast paced, dynamic environment. Ensures compliance  with established operational criteria, NCQA, and DHCS Standards, and PHC policies and  procedures. 

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

To research and resolve complex claims issues which cross interdepartmental lines and communicate the outcome to providers and affected Partnership managers. Develops and maintains provider training materials for all lines of business. Conducts provider trainings across Partnership departmental lines in group or individual provider settings. 

To facilitate access to medical care by coordinating Non-Emergency Medical (NEMT) Transportation, Non-Medical Transportation (NMT) transportation and travel-related benefits for members. Coordinates care in collaboration with internal and external partners to help members overcome barriers to care created by lack of transportation.

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

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.

Under the direction of the Manager of Performance Improvement, the Improvement Advisor is uniquely positioned to drive improvement across Partnership, 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

To research and resolve provider telephone and written inquiries within established time frames, accurately screen claims, and participate in provider meetings and projects. To accurately research and process paper and electronic medical, outpatient, ancillary, long term care, CHDP, encounter data and paper crossover/other coverage claims within established time frames, applying appropriate program policies related to claims processing and analysis.

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 plan, organize, manage, and implement projects.

  Manages day-to-day operations of transportation services and benefits offered by Partnership HealthPlan of California (Partnership). Provides leadership, support, and education to assigned staff, and maintains relationships with providers, Partnership contracted vendor(s), community partners, and county agencies, to promote collaboration and ensure smooth and consistent application of Partnership transportation benefits. Participates in various internal venues to enhance cooperation and understanding of how the transportation program interacts with other...

The AV Support Technician will help implement and maintain regional video collaboration tools to support Partnership HealthPlan’s communication needs. This role involves assisting with setup, basic troubleshooting, and providing support to staff and team members using AV equipment. The AV Support Technician will work closely with the AV Support Specialist and will be instrumental in ensuring consistent, high-quality AV experience throughout the organization.

  The Manager of Quality Incentive Programs is responsible for managing Partnership HealthPlan’s Primary Care, Hospital, and Long Term Care Quality Incentive Programs, also known as Quality Improvement Programs (QIPs). The QIPs provide financial incentives, data, and technical assistance to our provider network for meeting performance improvement targets. As part of this work, the position oversees Partnership’s Provider Data Portal which allows providers to evaluate their performance and obtain data to manage their patients and ultimately improve care.

The Manager of Medicare Marketing and Sales will oversee the development and execution of Partnership’s Medicare D-SNP marketing and sales strategy focused on driving smart and measurable growth. The Marketing manager will lead a team that collaborates with Partnership leadership to understand the unique opportunities within each market and deliver on sales and retention goals.

To begin Treatment Authorization Requests (TAR) reviews and perform data entry upon TAR determination by pharmacy staff. Performs eligibility and benefit investigations. Supports pharmacy department with extracting and collecting data for reporting needs. Supports department's administrative needs, and participates in special projects as assigned by pharmacy technician lead, supervisor, and departmental staff.

To oversee the appropriateness and quality of care delivered through Partnership HealthPlan of California and for the cost-effective utilization of services.

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,

To develop, implement, improve, and manage assigned programs. In addition to the Program Manager II duties, the Senior Program Manager is a leadership role, has a higher level of education/experience, more autonomy, exercises independent judgment, and provides coaching and guidance to less experienced program managers. 

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 review, research, and resolve claims for all Medi-Cal claim types within established production and quality standards, including manual processing. Completes and processes claims and claims worksheets. Creates appropriate documentation that reflects the actions taken and status of the claim. Generates provider communication, such as letters, as necessary. Routes and tracks claims requiring review by other staff and departments, and processes when possible. Claims Examiner II is distinguished from Claims Examiner I by a higher level of autonomy and experience, as well as an ability to process a wider range of claim types.