In collaboration with departmental and organizational leadership, supports the organization’s community reinvestment 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 disparity health outcomes.

To provide daily oversight, leadership, support, training and direction of both clinical and non-clinical staff. Supports and assists the Team Manager in developing and maintaining a cohesive team with a high level of productivity and accuracy to achieve the department's overall performance metrics. Designs and implements high quality, cost-effective care plans to enable members to achieve health goals.

Under the direction of the Associate Director of Internal Audit or above, the Cost Avoidance Manager is responsible for building, leading, and managing the HealthPlan’s Cost Avoidance and Recovery Teams. The purpose of the Cost Avoidance Team is to monitor payment of claims. The purpose of the Recovery Team is to identify overpayments for recovery; research and post

Daily supervision of the Data Coordinator/UM staff to ensure the highest level of customer service to the medical providers of the community.

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...

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

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

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,

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,

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 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.

 Responsible for developing, contracting, implementing, and maintaining new and existing provider networks. Manage and monitor contractual relationships with existing Partnership contracted providers. Assist with State and Federal Regulatory reporting of contracts and provider network. Supervise daily functions of Contracts Coordinator staff.

In collaboration with the HR Recruiters coordinates the ongoing recruitment and selection of industry experienced and leadership positions for Partnership HealthPlan of California (PHC) by providing assistance and administrative support. Professionally represents Partnership in frequent interactions with applicants, all levels of staff, and the public. Holds employee and applicant

Sr. Web Application Developer  Commission on Medical Care (DBA Partnership HealthPlan of California) is recruiting for our Fairfield, CA office: Sr. Web Application Developer: Design, develop, test and support enterprise-level client-server and web applications using C#, SSIS, ASP.NET, ASP.NET MVC, ADO.NET, JQuery, AJAX, Kafka, Azure, and Responsive Design frameworks. Design and document database schemas, develop stored procedures...

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.

  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 Senior Data Analytics and Reporting Developer serves as a technical leader in the design, development, and optimization of enterprise-level data reporting solutions. This role is responsible for architecting advanced dashboards, automated reporting pipelines, and analytical models that empower strategic decision-making across the organization. The Senior Developer collaborates with business leaders, drives best practices, mentors team members, and ensures data quality, scalability, and performance across reporting systems.

Manage day to day operations; provide leadership, support, and direction to the Provider Performance Oversight and Network Education and Training staff. Ensure the highest level of provider education, training, and oversight to ensure the network stays informed regarding policies and procedures, DHCS All Plan Letters and other State and Federal regulations. Monitor provider performance and identify opportunities for improvement. Monitor established goals and meet deadlines. Retain provider network through excellent customer service and education.

Supervise daily operations and provide leadership, support, and direction to assigned Provider Relations Representative staff. Ensure the highest level of customer service is a priority of PR staff. Monitor department goals and meet deadlines. Recruit and retain Provider network.

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