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 administrative support to the executive leader, leadership teams, and staff as assigned. In addition to the Administrative Assistant II duties, the Executive Assistant has a higher level of education and experience and more autonomy, works with a higher level of internal/external customers, serves as liaison to external customers, and a exposed to higher confidentiality. Responsibilities. Fields telephone calls. Receives and ...
Overview. Under direction from the Director of Care Coordination, manages and provides direction to the Care Coordination (CC) Department Managers and Supervisors for all services. Responsible for establishing and maintaining reports that will support the efficacy of department activity and producing a summary at least annually, or upon request, of CC program activities with documentation of department services, member outcomes, return on investm...
Overview. Works closely with business users and IT to write business requirements, test plans, implementation plans, and other project documentation. Understands and supports users with Partnership applications and assists in trouble shooting issues. Usually works on small to medium size projects but may work on larger projects depending on the situation. May assist the Senior IT Business Analyst on more complex projects. Responsibilities. Gains ...
Overview. Works closely with business users and IT to write business requirements, test plans, implementation plans, and other project documentation. Understands and supports users with Partnership applications and assists in trouble shooting issues. Usually works on small to medium size projects but may work on larger projects depending on the situation. May assist the Senior IT Business Analyst on more complex projects. Responsibilities. Gains ...
Overview. To support the Claims Department in maintaining pended claims and claim adjustments within established guidelines. Reviews and processes complex claims, and supports claims examining. Responsibilities. Researches and processes claim adjustment requests. Participates in special claim adjustment projects as assigned. Assists in maintaining pended claim reports and files within established department guidelines and program policies. Perfor...
Overview. To work with a dedicated and committed team, the RN Quality Investigator I is responsible for. assessing and improving the quality of care provided by the providers serving our members. Responsibilities. Potential Quality Issue Investigation and Resolution. Reviews potential quality issues that are referred to the QI department, including a review of allegations/complaints from members and providers that present adverse variation from e...
Overview. To supervise the claims auditors. claims fraud, waste, and abuse coordinators and the related job functions for each position. Ensures delivery of highest level of customer service to the community and its medical providers. Responsibilities. Supervises claims auditors and their job functions. Supervises the audit workflow. Supports claims audit functions. Maintains audit inventories within established goals. Supervises Claims Fraud, Wa...
Overview. Supervision of the Medi-Cal customer service outreach functions. Ensures delivery of the highest level of provider claims training to medical providers and the community. Responsibilities. . Coordinates with Claims Resolution Coordinators (CRCs) to develop provider educational/training materials for all Partnership lines of. Prepares a quarterly and monthly plan of action for the Director, identifying key provider outreach targets and ...
Overview. The State Hearing Representative has overall responsibility for assigned State Hearings, court cases for Partnership members contesting the outcome of Appeals and/or Grievances decisions. This position will represent Partnership HealthPlan of California at Department of Social Services (CDSS) court hearings. Responsible for establishing course of action to resolve conflict with Partnership members, case research, preparation of legal do...
Director of IT Business Systems. Job LocationsUS-CA-Fairfield. Job ID 2025-3840 FLSA Status Exempt Hiring Range $180,252.50 - $243,340.87. Overview. Under the direction of the CIO, the Director of IT Business Systems will be responsible for. overseeing the end-to-end intake, evaluation, and formalization of new technology initiatives. including software requests, solution proposals, IT evaluation of licensing agreements, and. software-related con...
