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.

Represents PHC 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, and PHC best practices. Works independently, provides leadership on each investigation, prioritizes case deliverables, remains customer-focused, and stays current on changes in the healthcare system that may trigger member dissatisfaction.

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.

This position will provide support to the Finance/Facilities department at Reception desks, in the Mailroom and with various Facilities and/or Finance related projects. This position may interact with all internal Partnership staff, visitors and guests, as well as vendors, in the course of project related tasks.

To establish and maintain excellent relationships with the transportation provider network. Identifies service gaps and recruits new transportation providers to increase network adequacy. Works closely to identify and resolve complex issues, provides education and staff training to transportation providers and healthcare providers with members experiencing transportation access issues. Assists providers with understanding Partnership HealthPlan of California's transportation-related policies and procedures and assists with resolving issues that arise.

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.

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.

The Enrollment Specialist I will assist in maintaining Medi-Cal membership and process basic functions of the Enrollment Unit. This position will review, research, and resolve Medi-Cal eligibility issues and systems related errors as well as primary care physician (PCP) assignment failures within established production and quality standards. Completes and processes reports and appropriately documents member records of actions taken to correct or update member records, PCP assignments etc. Processes reports to ensure primary care assignment is appropriate, processes certain authorized representative forms and document members records appropriately. Reports eligibility discrepancies and deceased members to appropriate counties and adds newborn records upon request...

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 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.

The Quality Data Validation Analyst is responsible for improving the quality and completeness of data used for Partnership’s Healthcare Effectiveness Data Information Set (HEDIS) reporting initiative. This position will focus on sets of measures required by federal and state regulatory bodies and collaborates with internal and external stakeholders to improve the exchange of clinical data that meets the requirements for use in the reporting and ensures that services completed within Partnership’s provider network are accurately leveraged in the HEDIS Project. This position is a key stakeholder on Partnership’s implementation of a Data Aggregator vendor solution and will partner with the vendor and internal...

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.

The Configuration Analyst provides both operational support to, and analysis of, lower complexity Configuration-related activities. The Configuration Analyst creates, updates, tests and maintains system configuration to support all benefit designs and ensure successful configuration, integration, and accurate and timely payment of claims and all PHC systems. Coordinates testing, quality assurance, configuration, installation, and support to ensure smooth, stable and timely implementation of technology solutions, considering all the areas that a change may impact in the current benefit setup and determine the most appropriate way to implement the change (e.g., research and...

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 Act as a Long Term Services and Supports (LTSS) Provider Liaison-Long Term Care Facilities and Skilled Nursing Facilities (SNF) including the responsibility of collaborating with internal departments to identify process improvement and maintaining consistent knowledge of benefit changes from the Department of Health Care Services.

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

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 serve as first level production support for conference rooms, desktops, phones, printing, software and other computer related operations.  Analyzes, investigates, and resolves reported issues. Determines underlying sources for problems and escalates issues to next level of support if necessary.

The Customer Service Representative I will answer and resolve provider telephone and written inquiries within established time frames. This position will accurately screen correspondence, perform research, refer to appropriate team as necessary, track follow-up to ensure completion, document all interactions with providers, research and complete various tasks, as appropriate for individual roles, such as claims review, provider dispute resolutions, provider surveys, provider change forms and paper and electronic correspondence within established time frames, applying appropriate program policies.

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.