To respond to member and provider inquiries regarding case management telephonically. Ensures that callers’ questions and/or problems are resolved or are directed to the appropriate person for resolution and/or entered as a referral for case management while providing the highest level of customer service.

Under the direction of the Manager of Performance Improvement, the Improvement Advisor is uniquely positioned to drive improvement across Partnership, our provider network, and the communities we serve. The Improvement Advisor will work internally and externally with provider practices and community partners to identify, plan, and facilitate quality improvement projects. Via

The Manager of Data Governance plays a critical role in leading and overseeing the data governance initiatives within the organization. This position is responsible for developing and implementing comprehensive data governance strategies, policies, and frameworks to ensure the integrity, security, and availability of organizational data across various systems including WEB, EDI, Data Warehouse, Infrastructure, Claims Payment System, and others.

The Senior Healthcare Data Analyst I contributes to the overall success of the organization by developing analytic solutions that support activities related to health services utilization management, care coordination, quality improvement and population health. Through analyzing patient claims, member enrollment, and other data, the Senior Healthcare Data Analyst

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.

To be the active project manager to deliver successful projects. Sets and follows clear project management standards including project plans, risk registers, and other project management documents. Responsible for the successful delivery of IT projects and assists in developing standards, managing the enterprise IT project priority list, and IT Steering Committee meetings. 

This position designs, develops, presents, and/or facilitates innovative and engaging organization-wide Instructor-Led Trainings (ILT), video trainings, and other trainings as requested. Works with department Subject Matter Experts (SMEs) on designing and/or standardizing targeted trainings (i.e. – department specific or audience specific trainings) as requested.

To provide coordination and implementation support of defined tasks for the assigned program(s).

To support and/or lead in planning, organization, management, and implementation of projects. In addition to the Project Coordinator I duties, a Project Coordinator II has a higher level of experience, works well with ambiguity and is expected to work with more autonomy on assignments. 

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

To prepare, analyze, report, and manage data used for both plan-wide and regional decision making for evaluating performance in key quality measures and the effective use of health plan resources on a routine and ad hoc basis. Works collaboratively with departments company-wide to identify data needs, develop and maintain data queries and tools, and complete accurate reporting to support performance and process improvements. Project/program involvement may include Partnership’s Healthcare Effectiveness Data Information Set (HEDIS) reporting initiative, Partnership Quality Dashboard (PDQ), Partnership’s provider pay-for-performance programs, and others as assigned.

To provide daily supervision of utilization management staff. Provide departmental leadership, support, resources and direction to staff. Assists in developing and maintaining a cohesive team with a high level of productivity, accuracy and quality to achieve departmental goals and objectives.

To plan, organize, manage, and implement projects.

The Manager of Vendor Oversight: D-SNP supports sourcing, contract execution, and performance management for vendor partners that directly support Partnership Advantage Dual Eligible Special Needs Plan (D-SNP). This position is responsible for relationship management with assigned vendors, as well as oversight of the contractual performance, maintenance of the vendor to ensure performance and compliance, building governance structures (JOC/AOC), implementing performance monitoring frameworks and ensuring all vendors meet regulatory and operational requirements during D-SNP implementation and after go-live. This position will be responsible for building relationships with business owners across the organization including:...

To provide high-level support for day-to-day PC operations, production operations support, systems and telecommunications support. Supports and leads all help desk functions with PC troubleshooting, performing software updates and maintaining the inventory of PC’s and network systems hardware. Serves as the primary, secondary, and/or tertiary level escalation point for desktop, VoIP, A/V, and connectivity support to internal customers/end users. Supports IT Operations efforts in the building, implementation, testing, and deployment of new servers, software, systems, network, and security changes. Primary operations support to production environment, maintains necessary skills related to production...

To coordinate application request review meetings with IT Leadership, maintain detailed schedule of IT projects, provide project status reports, oversee the application request process and ensure that System Development Life Cycle (SDLC) process is followed.

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

  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 Configuration Quality Assurance Analyst I is responsible for auditing of Configuration Analyst I and Configuration Specialists on system related job functions. Performs retrospective, concurrent, and special configuration audits. Collaborates with Configuration Technical Development and Quality Assurance teams to identify audit trends and staff training.

To analyze and interpret financial data and procedures to prepare financial information and reports. Applies generally accepted accounting principles and procedures (GAAP) to record, classify, and examine financial transactions. Participates in Month End Close responsibilities such as journal entry creation to book expenses and accruals, uploads these items to accounting system and reconciling sub ledger accounts. Participates in annual financial audit by preparing requested audit schedules and responding to ad hoc audit requests. Responds to customer base (i.e. employees, outside vendors, members) in a timely and professional manner