Collaborates with the Regulatory and Affairs Department to ensure PartnershipHealthPlan of California’s best interest... Must be available after normal work hours and/or weekends to ensure PartnershipHealthPlan of California meets all obligations accurately...
Overview: Supervise the day-to-day operations of PartnershipHealthPlan of California’s (Partnership) credentialing... California driver’s license and proof of current automobile insurance compliant with Partnership policy are required to operate...
to HealthPlan members referred to the Care Coordination Department for Case Management services and programs. The Health Care Guide... into the Care Coordination Department requesting assistance and information about available Partnership programs...
innovative and engaging eLearning courses;administers training courses to PartnershipHealthPlan 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...
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...
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...