potential reimbursement methodologies and rates, will provide organizational education related to Partnership’s network... Leadership Team or Partnership Board. o Ensures alignment of provider reimbursement strategies with Partnership mission...
Collaborates with the Regulatory and Affairs Department to ensure Partnership HealthPlan of California’s best interest... Must be available after normal work hours and/or weekends to ensure Partnership HealthPlan of California meets all obligations accurately...
Overview: Supervise the day-to-day operations of Partnership HealthPlan of California’s (Partnership) credentialing... California driver’s license and proof of current automobile insurance compliant with Partnership policy are required to operate...
innovative and engaging eLearning courses; administers training courses to Partnership HealthPlan of California staff..., as needed. Responsible for administering training courses to Partnership staff, with duties including but not limited to: Designs, delivers...
for all Partnership lines of business. Responsibilities: Perform concurrent and retro claims audits on new Claims examining staff.... Document audits and report all audit outcomes following the Partnership Claims Operating Instruction Memorandums on claims...
to the Director of Transportation. Assists staff and providers with the interpretation of Partnership policies, procedures... changes. Participates in all cost containment efforts of both the Health Services department and Partnership. Develops...
of Partnership’s computer systems, and technical and problem resolution support to the systems user community. Utilize knowledge... as a liaison for Claims to Configuration, Contracting, and Finance. Maintains in-depth knowledge of Partnership systems...
as assigned. Qualifications: Education and Experience Minimum three (3) years claims examining experience; or Partnership... claims examining experience and completion of Partnership claims training; or equivalent combination of education...
in Title 22, Medi-Cal Provider Manual, DMHC and/or CMS regulatory requirements and Partnership policies and procedures.... Works with other Partnership departments to resolve issues relating to authorization of medical services. Audits medical...
Overview: To oversee the appropriateness and quality of care delivered through Partnership HealthPlan of California..., in State Fair Hearings. * Engagement of the Partnership provider network to improve quality of care and member experience...
and maintenance. Responsibilities: - Manage the daily functions of the Systems and Data staff and monitor use of Partnership systems... and participate in selection of PR staff that are direct reports. - Participate in preparation and interview process for Partnership...
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...
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...
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...
Nurse in the State of California, or minimum five (5) years’ experience as a Registered Nurse preferably in a managed care..., Licenses and Certifications Licensed as a Registered Nurse in the State of California, Certification in Case Management Area...
. Typing speed 30 wpm and proficient use of 10-key calculator preferred. Valid California driver’s license and proof of current... required, ability to move, carry, or lift objects of varying sizes, weighing up to 10 lbs. All HealthPlan employees are expected...
. Typing speed 30 wpm and proficient use of 10-key calculator preferred. Valid California driver’s license and proof of current... to move, carry, or lift objects of varying sizes, weighing up to 10 lbs. All HealthPlan employees are expected...
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...
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...