Overview. 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 t...
Overview. 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. Responsibilities. Provides administrative support to management and general office and clerical duties as needed to support the department. Documents desk procedures and updates annually to ensure content is current. Enters data into vario...
Overview. This position works with the Benefits team to administer the entire Employee Benefits Program,Workers’ Compensation Program, Benefits Open Enrollment Program, and PHC sponsoredEmployee Life Insurance. The Benefits Coordinator is responsible for providing a full range ofHR customer service support. This position also performs general HR benefits duties such asadministrative and clerical support, organizing and scheduling meetings, and ot...
Overview. The Sr. Manager of HRP Transaction Management will oversee and manage HRP Transaction Management functions effectively. This entails leading a team, prioritizing tasks, establishing and enforcing standards, training staff, testing and implementing new code, analyzing user requirements, and aligning work with business priorities. Responsibilities. Lead Health Rules Payer (Claims System) Transaction Management responsibilities. Maintain c...
Overview. 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...
Overview. This position is responsible for coordinating Facilities related functions and to provide assistance to Partnership HealthPlan of California (PHC)s Facilities department. This position will interact with all internal PHC staff as well as various supply vendors and maintenance personnel. Provides the necessary assistance to the Facilities team with a high level of integrity, strong organizational skills and professionalism. Responsibilit...
Overview. Under the general direction of the Associate Director of Health Analytics, this position isresponsible for managing the Health Analytics Team at PHC. The goal of the Health AnalyticsTeam is to help PHC improve the health of our members and the communities we serve bydeveloping and producing high quality analytic reports of health care data for use internally andexternally. To achieve this, the Manager of Health Analytics will manage, me...
Overview. Under the direction of the Manager of Performance Improvement, the Improvement Advisor isuniquely positioned to drive improvement across PHC, our provider network, and the communitieswe serve. The Improvement Advisor will work internally and externally with provider practicesand community partners to identify, plan, and facilitate quality improvement projects. Viaindividualized facilitation, this position will coach and train improvemen...
Overview. 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 or s...
Overview. Part of a multidisciplinary team, responsible for clinical oversight of assigned grievance andappeal cases. Utilizes clinical judgement in the assessment, solution, and/or guidance of casesto ensure members receive high quality healthcare services. Working closely with PHC MedicalDirectors, oversees assessments for medically necessary determinations, quality of careconcerns, allegations of abuse, fraudulent acts or wasteful activity. Pr...
Overview. The IT Quality Assurance (QA) Analyst is primarily responsible for testing all IT applications that are either built in-house or the integration of commercial off the shelf products that integrate with our in-house applications to ensure they meet requirements and are of high quality. The QA Analyst collaborates with internal and external technical associates such as Business Analysts and Application Developers to plan, test, and implem...
Overview. To assist and support the Director with development, implementation, and maintenance of. professional, facility, and ancillary contracts for the PHC provider network. The Contracts. Coordinator II is responsible for, Contracting Department tracking, and reporting provider network. activities, including of scanning contract documents, mailing or emailing network notices related. to contracting, initiating contracts and supporting daily c...
