The Human Resources Leave and Accommodation Administrator serves as the primary point of contact and subject matter expert for employee leave and accommodation matters. This role guides employees and managers through the leave and accommodation processes, ensures an efficient and supportive experience, and maintains strict compliance with all applicable federal and state

The Configuration Quality Assurance Analyst II is responsible for auditing Configuration staff up to Analyst II functions on system related functions. Performs retrospective, concurrent, and special claims audits on assigned configuration projects. Completes audit documentation and reports. Collaborates with Technical Development and Quality Assurance teams to identifying trends for training purposes. Performs all activities related to auditing, tracking and documenting staff performance of operational processes for the Configuration department. Provides feedback and recommendations to the Configuration leadership team on trends and staff training.

Under the general direction of the CIO, the Director, IT Strategic Initiatives is responsible for overseeing IT strategic initiatives; developing, implementing, and auditing methodologies and best practices related to steering committees; and prioritization of projects and best practices related to the Systems Development Life Cycle (SDLC). The Director will be responsible for ensuring that there is a consistent development and implementation process and that it is followed. The Director will work with the CIO and other department directors to prioritize projects and provide status reports to the CIO and Steering Committee.

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.

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.

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

The IT Data Quality Analyst supports the development and execution of IT data quality processes across IT teams and functions. Under guidance from senior staff, this role assists in identifying IT data quality gaps, performs data profiling and analysis, and helps maintain processes that ensure organizational data is accurate, complete, and compliant. The analyst works collaboratively across IT and operational teams to investigate data issues and contribute to ongoing IT data quality improvement efforts.

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.

To provide clerical and general office support for department functions.

Responsible for the delivery of business intelligence solutions across the enterprise. Manages deployment, maintenance, and support of data access tools and reports.

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.

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 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,

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.