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Job Locations US-CA-Redding
To respond to member and provider issues and inquiries. Ensures that callers’ questions and/or problems are resolved or are directed to the appropriate person for resolution and provides the highest level of customer service.
Job ID
2021-2001
FLSA Status
Non-Exempt
Job Locations US-CA-Redding
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.
Job ID
2021-1998
FLSA Status
Non-Exempt
Job Locations US-CA-Redding
To provide coordination and administrative support to department managers. Performs a variety of general clerical duties, including data entry, report generation, and develops forms and presentations.
Job ID
2021-1997
FLSA Status
Non-Exempt
Job Locations US-CA-Redding
Initiate and coordinate a multidisciplinary team approach for members with transportation needs. This position will include care coordination as identified during the transportation process.
Job ID
2021-1996
FLSA Status
Non-Exempt
Job Locations US-CA-Redding
To initiate and coordinate a multidisciplinary team approach to case management. Engages the member/member’s representative in a care plan that assists a 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.
Job ID
2021-1995
FLSA Status
Non-Exempt
Job Locations US-CA-Redding
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.
Job ID
2021-1994
FLSA Status
Non-Exempt
Job Locations US-CA-Redding
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.
Job ID
2021-1993
FLSA Status
Non-Exempt
Job Locations US-CA-Redding
To review, research, and resolve claims for all Medi-Cal claim types within established production and quality standards, including manual processing. Creates appropriate documentation that reflects the actions taken and status of the claim. Generates provider communication, such as letters. Routes and tracks claims requiring review by other staff and departments, and processes when possible.
Job ID
2021-1991
FLSA Status
Non-Exempt
Job Locations US-CA-Redding
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.
Job ID
2021-1990
FLSA Status
Non-Exempt
Job Locations US-CA-Fairfield
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.
Job ID
2021-1989
FLSA Status
Non-Exempt
Job Locations US-CA-Fairfield
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.
Job ID
2021-1988
FLSA Status
Non-Exempt
Job Locations US-CA-Fairfield
To manage and coordinate incoming grievances and appeals and provide administrative support for the Grievance Unit. Assesses and completes appropriate documentation for tracking and trending date, which may include conducting all pertinent research on a level one grievance in accordance with all established regulatory guidelines. Reviews delegated grievance logs and processes requests for grievance data and reporting.
Job ID
2021-1987
FLSA Status
Non-Exempt
Job Locations US-CA-Fairfield
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.
Job ID
2021-1986
FLSA Status
Non-Exempt
Job Locations US-CA-Fairfield
To effectively train, implement, and communicate program management best practices across the organization ensuring accuracy, consistency, and thoroughness. Program Managers are responsible for the planning, communication, ongoing support, and execution of program improvements. Different from the Program Manager II, 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. Leads program management for cross-functional, internal, external, and complex programs and may directly supervise program roles. Provides day-to-day management of reporting including research, business and financial analysis, problem solving, issue tracking, and resolution.
Job ID
2021-1985
FLSA Status
Exempt
Job Locations US-CA-Fairfield
To manage and coordinate incoming grievances and appeals and provide administrative support for the Grievance Unit. Assesses and completes appropriate documentation for tracking and trending date, which may include conducting all pertinent research on a level one grievance in accordance with all established regulatory guidelines. Reviews delegated grievance logs and processes requests for grievance data and reporting.
Job ID
2021-1984
FLSA Status
Non-Exempt
Job Locations US-CA-Fairfield
Under the direction of the Associate Director of Communications and Public Affairs, the Communications Supervisor is responsible for the development and execution of PHC communication strategies. The Communications Supervisor will proactively advance PHC’s mission, strategic plan, and being a valued neighbor in the communities served by PHC.
Job ID
2021-1983
FLSA Status
Exempt
Job Locations US-CA-Fairfield
To effectively communicate and implement project management methodologies required to drive the planning, implementation, and tracking of projects through all aspects of the project lifecycle. Project Managers are responsible for the planning, procurement and execution of a project. Projects are time bound with a distinct start and end point. Ensure accuracy, consistency, and thoroughness of projects.
Job ID
2021-1981
FLSA Status
Exempt
Job Locations US-CA-Fairfield
To train all levels of Examiner and Customer Service staff on related claim processing functions for all lines of business using Amisys Advance system and Claims Operating Instruction Memorandums. Performs retrospective, concurrent, and special claims audits on all claim types for all PHC lines of business. Completes audit documentation and reports. Provides feedback and recommendations to the Claims Audit Supervisor and Associate Director of Claims Technical Support on department audit trends and staff training.
Job ID
2021-1979
FLSA Status
Non-Exempt
Job Locations US-CA-Fairfield
The Associate Director of Regulatory Affairs and Compliance will leadregulatory initiatives across all functions in the HealthPlan and manage relationships and maintain communications with state and federal regulatory agencies and stakeholders at all levels, both internally and externally. This position will conduct analysis of regulatory policies and communications, and make recommendations to leadership regarding regulatory affairs and compliance and provide leadership and direction in establishing and monitoring operational compliance with regulations.
Job ID
2021-1976
FLSA Status
Exempt
Job Locations US-CA-Redding
Working with a dedicated and committed team, the Performance Improvement Clinical Specialist (PICS) is responsible for assessing and improving the quality of care provided by the providers serving our members.
Job ID
2021-1974
FLSA Status
Exempt