as assigned. Qualifications: Education and Experience Minimum three (3) years claims examining experience; or Partnership... coding. Knowledge of Partnership Claim Policy and Procedures, EDS provider manual guidelines, Title 22 regulations...
-specific records in the Partnership computer system, in databases and files as applicable. Participates in committees..., workgroups and/or multidisciplinary teams to support Partnership’s strategic plan, organizational goals, and/or business needs...
, Visio, and PowerPoint. Valid California driver’s license and proof of current automobile insurance compliant... with Partnership policy are required to operate a vehicle and travel for company business. . Performance Based Competencies...
, facility, and ancillary contracts for the Partnership provider network. The Contracts Coordinator II is responsible...-standing facilities, ancillary, and other provider types for all Partnership programs. * Assist with obtaining contract...
a review of all relevant medical records. * Obtain responses from provider(s) and appropriate Partnership departments. When... activities as determined by the Peer Review Committee or Partnership policy. * Generates a request for a Corrective Action Plan...
combination of education and experience. CCM desired. Knowledge of Partnership Grievance & Appeals processes desired. General... California Registered Nurse license required. Must be a critical thinker and organized. Thorough knowledge of utilization...
will ensure all IT purchases are completed in a timely manner, in compliance with current Partnership HealthPlan of California... Certification or equivalent experience is a plus. Valid California driver’s license and proof of current automobile insurance...
with understanding Partnership HealthPlan of California's policies and procedures and assists with resolving issues that arise... for research and entry of information. Valid California driver’s license and proof of current automobile insurance compliant...
Team and is responsible for leading a growing Quality Department at Partnership HealthPlan of California (PHC) through...’s Partnership Improvement Academy, DCHS mandated improvement work, performance improvement and engagement activities done with the...
of various computer system software including Windows, Microsoft Word, Excel, Outlook, Visio, and PowerPoint. Valid California... driver’s license and proof of current automobile insurance compliant with Partnership policy are required to operate...
, and department metrics are being met. Establishes and maintains professional working relationships with Partnership partners.... Current California Registered Nurse License. Valid California Driver's License and proof of current automobile insurance...
California driver’s license and proof of current automobile insurance compliant with Partnership policy are required to operate.... Must be able to lift, move, or carry objects of varying size, weighing up to 10 lbs. All HealthPlan employees are expected...
system software including Windows, Microsoft Word, Excel, Outlook, Visio, and PowerPoint. Valid California driver’s license... and proof of current automobile insurance compliant with Partnership’s policy are required to operate a vehicle and travel...
Overview: Implements Partnership HealthPlan of California (PHC) communications strategies through impactful member...; existing relationships with community-based and Partnership-associated organizations; familiarity with California Medi-Cal...
California driver’s license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle... cabling, systems hardware, and other related equipment. All HealthPlan employees are expected to: Provide the highest...
Current and unrestricted California Registered Nurse License. Valid California driver’s license and proof of current... lbs. All HealthPlan employees are expected to: Provide the highest possible level of service to clients; Promote...
and/or analytical staff. Maintains current knowledge of NCQA accreditation; US Center for MediCal and Medicaid services and California... and Certifications Current California Registered Nurse license required. Knowledge of healthcare total quality management theory...
requirements and project budget. Valid California driver’s license and proof of current automobile insurance compliant with PHC.... All HealthPlan employees are expected to: Provide the highest possible level of service to clients; Promote teamwork...
literacy and proficiency. Familiarity with managed care and/or utilization management preferred. Valid California driver.... All HealthPlan employees are expected to: Provide the highest possible level of service to clients; Promote teamwork...
to HealthPlan members referred to the Care Coordination Department for Case Management services and programs. The Health Care Guide... of managed care. Ability to learn the following: case management role within a health plan setting, and the HealthPlan...