Jobs at Partnership HealthPlan of California

Conducts independent investigations involving HIPAA, healthcare fraud, waste and abuse, privacy, and compliance matters. Prepares investigative reports and regulatory submissions, coordinates with DHCS and other agencies, analyzes case trends, maintains case-management systems, supports quality assurance, and contributes to compliance training and process improvements. Requires managing assigned caseloads, handling sensitive information, and providing recommendations to leadership and internal departments.

Manages assigned perinatal programs through implementation, daily operations, reporting, stakeholder coordination, meetings, events, communications, invoicing, and continuous improvement. Reviews data quality, monitors program performance, tracks deliverables and risks, prepares leadership reports, supports strategic initiatives, leads demonstrations and training, and maintains program documentation. Requires strong organization, communication, problem-solving, software proficiency, and the ability to travel for company business.

Manages assigned programs from implementation through continuous improvement. Responsibilities include tracking data, reviewing submissions and invoices, monitoring reports, coordinating meetings and events, preparing stakeholder communications and reports, facilitating training, managing documentation, identifying risks, and recommending improvements. The role works with internal and external stakeholders, supports strategic initiatives, and requires program management, organizational, communication, and analytical skills.

Administers, architects, secures, and optimizes the organization’s Microsoft 365 environment, including Exchange Online, Teams, SharePoint, OneDrive, Intune, Defender, and Azure Active Directory. Responsibilities include identity and access management, endpoint administration, troubleshooting, incident response, service monitoring, platform updates, migrations, documentation, Tier 3 support, automation, disaster recovery, governance, and user adoption. The role collaborates with cybersecurity, helpdesk, and infrastructure teams and participates in on-call rotations and occasional travel.

Researches and resolves complex provider claims inquiries, appeals, grievances, and payment issues. Coordinates with Claims, Member Services, Health Services, IT, and provider relations teams. Develops provider training materials, conducts trainings, processes adjustments, runs Business Objects reports, analyzes denial trends, distributes scorecards, and presents recommendations. Tracks complaints and system issues while supporting special projects and ongoing claims process improvements.

Manages IT projects from planning through delivery, including scope, requirements, milestones, project plans, risks, status reporting, documentation, and stakeholder communications. Leads cross-functional teams, facilitates project kickoffs, IT Steering Committee and CAB meetings, and ensures adherence to SDLC processes. Supports IT project prioritization, standards, policies, and procedures while coordinating technical and non-technical stakeholders, vendors, and system administrators.

Leads utilization management across health plan product lines, directing managers and supervisors, overseeing claims reviews, appeals, audits, regulatory compliance, reporting, training, quality improvement, and cost containment. Coordinates with internal departments, providers, and delegated organizations to resolve care and member issues. Requires a California RN license, clinical and managed care experience, management expertise, and knowledge of utilization criteria, case management, coding, and Medi-Cal programs.

Provides nursing case management for health-plan members across medical, behavioral, and psychosocial needs. Coordinates individualized care plans, referrals, authorizations, medical records, providers, community resources, and multidisciplinary teams. Supports continuity of care, quality outcomes, accurate documentation, and member wellness goals. Requires independent caseload management, clinical judgment, communication, critical thinking, and compliance with NCQA standards and California nursing regulations.

Manages ongoing programs from implementation through continuous improvement. Responsibilities include tracking data, reviewing invoices and reports, coordinating meetings and events, preparing stakeholder communications and documentation, monitoring deliverables and risks, leading trainings and demos, and supporting strategic initiatives. The role requires collaboration across organizational levels, program evaluation, process improvement, and compliance with established procedures.

Manages organization-wide quality and performance improvement initiatives, including the Partnership Improvement Academy, project portfolio, internal training, provider consultation, analytics coordination, and improvement methodology. Leads and develops performance improvement staff, oversees resources and timelines, supports healthcare quality strategy, and advises teams on practice transformation, measurement, and data-driven improvement across provider networks and internal departments.

Supports planning, coordination, implementation, and documentation for low- to medium-complexity projects. Maintains project plans, budgets, deliverables, data, records, and version control; assists with business cases, process implementation, stakeholder follow-up, communications, meetings, agendas, and minutes. Coordinates events and webinars, uses project management and collaboration tools, and provides administrative and technical support to project teams.

Leads Medicare D-SNP marketing and sales strategy, enrollment and retention growth, community outreach, creative production, regulatory compliance, broker oversight, performance tracking, and team development. The role manages marketing plans, monitors competitive conditions, supports sales events, investigates grievances and disenrollment, coordinates with clinical and compliance teams, and reports results to stakeholders.

Reviews, researches, and resolves pending Medi-Cal claims across medical, ancillary, long-term care, encounter, batch, and other claim types. Processes claims and worksheets, documents actions, prepares provider correspondence, routes claims for additional review, follows up on responses, and complies with Medi-Cal, CMS, Title 22, and organizational guidelines. Tracks production, completes audits, identifies trends, and recommends process improvements while meeting quality and productivity standards.

Designs, develops, tests, deploys, and supports client-server, web, desktop, and mobile applications. Responsibilities include database schema design, SQL and Oracle programming, reusable enterprise libraries, SharePoint customization, SSIS package conversion, production troubleshooting, code reviews, testing, source control, and server support. The role collaborates with IT staff and business analysts to automate processes and support managed-care systems, including AMISYS Advance.

Administers and maintains HR systems, including LMS, performance, wellness, and engagement platforms. Ensures data integrity, regulatory compliance, access controls, troubleshooting, upgrades, reporting, and vendor coordination. Supports training program administration by managing courses, curricula, workflows, training plans, documentation, and progress tracking. Provides technical support and user training, develops reports and databases, coordinates projects, and identifies process improvements. Requires strong Excel, analytical, organizational, communication, and problem-solving skills.

Provides administrative support to department leadership and staff by managing calendars, meetings, correspondence, reports, expense documentation, travel arrangements, supplies, filing systems, timesheets, training requests, and events. The role also handles calls and visitors, prepares meeting materials and minutes, coordinates communications, and supports departmental reporting. Requires strong organization, communication, attention to detail, confidentiality, Microsoft Office proficiency, and occasional business travel.

Processes biweekly payroll, audits timekeeping and ADP entries, handles employee reimbursements, records payroll expenses and accruals, reconciles benefits and retirement contributions, responds to compensation inquiries, maintains confidential payroll records, prepares audit schedules, and produces financial reports. Applies GAAP and supports month-end close, variance analysis, and compliance with federal and California labor regulations.

Supports the development, evaluation, modeling, implementation, and negotiation of provider reimbursement methodologies and managed care payment arrangements. Performs complex financial, strategic, and data analysis involving rates, contracts, risk arrangements, bundled payments, and provider network adequacy. Advises leadership, supports contracting and audits, maintains reimbursement policies and rate repositories, monitors regulatory changes, and educates stakeholders on provider payment strategies and procedures.

Audits employee benefit enrollments, payroll deductions, vendor invoices, eligibility, and benefit system data. Manages COBRA administration, ACA compliance reporting, HSA and retirement contributions, EDI enrollment feeds, open enrollment support, and annual benefits projects. Maintains confidential employee and payroll records, resolves discrepancies, supports ADP benefits updates, and assists with compliance reporting, employee events, and related HR activities.

Leads projects through planning, procurement, execution, tracking, and closeout. Develops project plans, charters, budgets, business cases, communications, and documentation; manages deliverables, dependencies, timelines, resources, risks, and stakeholders. Coordinates meetings, events, conferences, and webinars, facilitates process implementation and handoffs, analyzes project results, and ensures projects meet scope, schedule, cost, and quality requirements.