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.
Under the general supervision of department leadership, the Quality and Training Supervisor will lead the design and structure of the department’s Quality Assurance (QA) and training program. Responsibilities include: designing, developing, implementing, and managing all quality and training activities for the department. Additionally, the supervisor is responsible for driving the attainment of quality metrics and to achieve superior results. Through demonstrated individual performance, the Quality and Training Supervisor shall promote the highest standards of ethical and professional conduct to lead staff members by example.
To provide daily oversight, leadership, support, and management of assigned nonclinical staff. Ensures compliance with established criteria, regulations, standards, best practices and Health Plan benefits, in a fast-paced and ambiguous environment.
To assess and complete appropriate documentation for tracking and trending data. Responsible for written responses to all incoming correspondence, including all grievances from members, providers and outside agencies as well as second level and above appeals from members and/or providers for all lines of business.
Manages the administration of various Human Resources functions including recruitment and general HR administration. This includes performance management, employee development, process improvement, and other development initiatives to improve the company’s performance. Works closely with top level management to establish policies and implement procedures for the management of Human Resources to accomplish the goals and objectives of PHC within budget and within applicable legal requirements.
*Candidate must have healthcare experience.
To provide daily oversight, leadership, support, training and direction of nonclinical staff. Supports and assists the Team Manager and other Case Management Supervisors in developing and maintaining a cohesive team with a high level of productivity and accuracy to achieve the department's overall performance metrics.