Job Description

Location: Novato, CA

Employment Status: Full Time-Exempt

Position Summary:
The Data Engineer designs database structures that support the business needs of end users. Manages data integration & data ingestion pipelines; ETL, EDI, data quality & standardization. Responsible for building and supporting Cloud Data Lake/Data Warehouse. Evaluates hardware and software platforms and ensures system integration. Oversees metadata strategy, data cleansing and cloud data security strategy.
Job Duties and Responsibilities • Analyze and organize raw data from various sources • Build data delivery systems and pipelines for use in Reporting, Forecasting, and Data transferring through API’s • Identify, design, and implement internal process improvements including re-designing infrastructure for greater scalability, optimizing data delivery, and automating manual processes • Build infrastructure required for optimal extraction, transformation, and loading of data from a wide variety of data sources • Prepare data for prescriptive and predictive modeling • Explore ways to enhance data quality and reliability • Collaborate with internal and external business partners
• Is accountable for work performed, works to develop, and maintain trusting working relationships with others.
• Seeks to continuously learn from errors and experiences, as well as new developments in job specific areas.
• Performs other than normally assigned duties, as directed, and required, within and outside of the department to support Meritage’s business needs.
• Adopts, incorporates, is mindful of, and otherwise supports Meritage’s overarching annual and longer-term business goals and objectives while performing work duties, special projects and other duties as assigned within or outside of the Department.
• Consistently demonstrate behaviors, conduct and communications that support Meritage’s Practices and Values of Accountability, Diversity, Integrity and Respect for others, and seeks to influence these behaviors in others.
• Continuously endeavors to “raise the bar” of performance and teamwork through a focus on Innovation, Collaboration, Equality and Compassion.

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Job Requirements

Skills and Qualifications
• Ability to build and optimize Data Sets
• Ability to perform root cause analysis on internal and external processes and to identify opportunities for improvement
• Experience in data integration & data ingestion pipelines (ETL, EDI, etc.)
• Excellent analytic skills associated with working on unstructured datasets
• Ability to build processes that support data transformation, workload management, and data structures.
• Ability to effectively communicate complex data to both technical and non-technical people Requirements • 3-years’ experience as a data engineer or relevant experience • Bachelor’s degree in Computer Science and or a combination of experience and education. • Technical expertise with data models, data mining, and segmentation techniques • Strong experience with SQL, data integration (ETL & EDI) • Experienced in Cloud Services (preferably Azure or AWS, GCP)
• Strong working knowledge of Microsoft SQL, Cloud Data Lakes/DW preferably Azure SQL Synapse or any of the following Amazon Redshift, Google Big Query, Snowflake, Cloudera
• Good knowledge of one of the industry Cloud Data Lakes/DW platforms
• Great numerical and analytical skills
• Additional vendor specific certification desirable

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Job Description

Location: Fresno & Madera County

Employment Status: Full Time

Position Summary

The outpatient RN Care Manager is the key contact with the patient and providers. They are responsible for providing comprehensive assessments and developing, coordinating, and implementing the plan of care with other team members on those patients assigned. Maintain extensive knowledge regarding the current standards of care and care management processes for Asthma, COPD, Diabetes, Heart Failure, and/or other Program specified condition(s). Involved in two main programs at Meritage: Care Transitions and Complex Care Management.

Principal Responsibilities:

Care Transitions Program:

• Provide post hospital discharge support to all Meritage members who qualify for Care Transitions (depending on health plan)- based on Coleman Model (30-day program).
• Patients will receive either telephonic or face-to-face care transitions support.
• Use Criteria such as the LACE tool to identify high risk patients.
• Goals and objectives:
  • Reduce preventable readmissions
  • Increase the number of patients that are seen by an MD within 7-10 days of discharge
  • Provide medication reconciliation and assist in identifying and correcting medication discrepancies
  • Provide teaching regarding disease process, medications, community resources
  • Educate members on seeking the appropriate level of care
  • Reduce utilization costs by evaluating users with high outpatient costs
  • Refer patients as appropriate to Behavioral Health Care Manager
  • Create personalized care plan for patient

Complex Care Management:

• CCM services to those patients identified as high risk and will be referred into the program.
• Patients referred into the program will receive telephonic support for up to 90 days, as well as a home visit from the RN Care Manager (RN CM).
• Identify patient centered goals and create personalized Plan of Care.
• Work with patient to achieve goals of care.
• Educate patient regarding disease processes, medications, community resources
• Provide medication reconciliation as appropriate
• Assist members with seeking appropriate level of care
• Provide referral to Behavioral Health Care Management if appropriate
• Work with Utilization Review for authorizations/provider referrals as appropriate
• Work with quality department to improve quality scores
• Patients who receive a home visit will also receive three follow up phone calls to address any ongoing needs, questions, or concerns.
• RN CM may provide the following via telephone or home visit (if deemed clinically appropriate):
• Assessment of patient health status
• Identify patient centered goals and create plan of care
• Educate patient regarding disease processes; signs and symptoms, when to notify MD
• Interdisciplinary collaboration with MDs, therapists, home health agencies, family, etc.
• Discussion of preventative health measures
• Medication reconciliation/discrepancies
• Teaching of disease process, signs, and symptoms to be concerned about and when to call the doctor
• How to seek the appropriate level of care
• Referral to community resources/caregivers etc. as appropriate
• Home safety evaluation/falls risk assessment
• Review of life planning/advanced care directions
• Review of hospital discharge instructions if indicated
• Work with UM for proper authorizations/providers if indicated
• Provide ongoing support for patient to achieve goals
• CCM patients are brought into weekly rounds with medical director

SNF 3-day Waiver Program:

• Participate in the 3-day waiver program
  • Point person for hospitals, Skilled Nursing Facilities, primary care provider
  • Care transitions/CCM for fee for service Medicare/ Medicare advantage beneficiaries who qualify for the 3-day SNF waiver (see above for duties for each service)

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Job Requirements

Qualifications

• RN with current, unrestricted license in the state of California, BSN/MSN preferred or CM certification
• Bachelor’s degree from a four-year college and/or a professional certification requiring formal education beyond a two-year college.
• 2+ years’ experience in inpatient or outpatient nursing. Case Management experience highly preferred.
• Able to work with different healthcare settings: Inpatient vs. Outpatient

Skills and Requirements:

• Knowledge of CM regulations that fall under CMS, NCQA, DMHC and other applicable state and accreditation standards.
• Demonstration of sound clinical judgment and critical thinking in accordance with the California Nurse Practice Act.
• Commitment to service excellence and patient satisfaction.
• Proficiency in office-based software applications, including Word, Excel, Outlook, and working knowledge of other Healthcare Charting software required.
• Ability to develop and maintain effective working relationships with other teammates, patients, and the public.
• Ability to multi-task in a fast-paced clinical setting.
• Excellent verbal, written and interpersonal communication skills.
• Aptitude for coaching, training, and developing new teammates.
• Ability to collaborate and build strong client relationships across all levels of the organization including clinical staff, physicians, and administrative leadership to meet deliverables.
• Able to drive in own car to patient homes/ facilities when applicable.

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Job Description

Location: Novato, CA

Employment Status: Full Time

Position Summary

Reporting to the Vice President of Clinical Programs, the Director will oversee all management staff, operations and services/programs in the Care Management, Utilization Management, Quality, and Clinical Review/RAF departments. Responsible for ensuring that all assigned programs and services align with and support company business objectives and strategic plans. Leads assigned management team to achieve highest levels of efficiency, quality, financial stewardship, and regulatory compliance for their respective areas. Works to support and strengthen working relationships efforts among and between assigned departments, with leadership and staff across Meritage and with Babylon Health to optimize deliverables and outcomes. Works cooperative, collegially and effectively with other Meritage and Babylon leadership, Medical Officer and Directors, and counterparts at business partner, affiliated and ancillary business entities. Responsible for the development and adherence to policies, procedures, practices for assigned areas. Ensures high levels of productivity and capabilities of staff, adherence to the highest standards of clinical care services, and compliance with all health plan and government regulatory requirements. Serves as a primary contact and point person with outside auditors, health plan representatives, regulatory agencies and other 3rd parties for assigned areas. Is responsible for developing and tracking key metrics for assigned areas to monitor and report efforts, activities and outcomes for improved business decisions. Ensure the organization passes all required audits, including HEIDS and NCQA.

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Job Requirements

Requirements

• Bachelor’s Degree in Nursing or related field, Master’s Degree strongly preferred, with a minimum of 7 to 10 years of directly related increasingly responsible healthcare management experience; or, equivalent combination of education and experience.
• Current and unrestricted RN license.
• Previous experience in developing clinical and quality programs
• Demonstrated knowledge of Medicare, Medi-Cal/Caid, DMHC, commercial Health Plans, and other related local, state, and federal regulations.
• Strong analytical and technical skills, experience developing metrics and reporting systems and dashboards.
• Strong Microsoft Office skills; Excel, Word, PowerPoint, and working knowledge of various EHR systems.
• Effective oral, written and listening communication skills.
• Demonstrated professional demeanor with a collaborative and collegial work style that models and reinforces respect, accountability, innovation and integrity.

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Job Description

Location: Novato, CA

Employment Status: Full Time

Position Summary

 

Prepares consolidated financial statements including balance sheets, income statements, and cash flow statements. Reviews and analyzes account balances, verifies accuracy, prepares reconciliations and other supporting schedules, investigates issues and makes recommendations for corrections. Develops and enhances accounting/finance applications and reports based on management needs for performance measurement. Provides guidance, assistance and back-up to other accounting and support staff as required/assigned, including revenue, accounts receivable/payable, payroll, and provider compensation.

 

Essential Job Responsibilities

• Supports month-end and year-end close processes and prepares accurate, timely financial statements in accordance with established schedule.
• Performs regular general ledger updates and maintenance using Microsoft Dynamics accounting software.
• Conducts monthly and quarterly account balance reconciliations to ensure accurate reporting.
• Analyzes financial statements for discrepancies and other issues that should be brought to the CFO’s attention.
• Participates in budgeting processes and prepares budget variance reports and analysis.
• Assists CFO with preparation for annual audits.
• Develops and documents policies and procedures to maintain and strengthen department processes and internal controls.
• Conducts other finance-related analysis and prepares reports to support management objectives.
• Assists with the training of department staff, cross-trains to provide back-up for other finance department processes.
• Adheres to required GAAP standards.

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Job Requirements

Education, Experience and Qualifications

• Bachelor’s degree in accounting. CPA or CPA-ready is preferred or a combination of experience and education.
• Minimum 5 years of current professional hands-on accounting experience including 3-5 years in a health care organization, managed care environment preferred. Additional experience with accounts payable and payroll is a bonus.
• Ability to work at an advanced level with Excel and accounting applications (Microsoft Dynamics Great Plains or similar).
• Ability to perform mathematical computations and compute ratios and percentages.
• Skill in defining problems, collecting data, interpreting financial material.
• Skill in preparing statistical and narrative accounting and auditing reports.
• Ability to communicate clearly and to maintain effective working relationships.

 

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Job Description

Location: Novato, CA Hybrid

Employment Status: Full Time

Position Summary:
The Care Management Administrative Support Supervisor designation carries additional duties and responsibilities that overlay a senior lead staff member’s regular job responsibilities in a functional area when its determined that the area needs greater on-site supervision of staff and operational oversight than is previously been provided to a work team. The Supervisor is also responsible for the following: Coordinate, schedule, and arrange internal and provider meetings as needed, including reserving locations, coordinating, and disseminating handouts and other printed/electronic meeting materials for Department Manager, the Risk Adjustment Medical Director, and the UR medical director. The Supervisor engages in leadership and first line management responsibilities on average, greater than 50% of the time.

Department administrative duties:
• Maintain meeting minutes and records.
• Work with the director of care management to plan and schedule staff meetings.
• Mailings and data entry for special projects.
• Assist any member of the Care Management department staff as needed.

Principal Accountabilities:
• Respects patients by recognizing their rights; maintaining the confidentiality.
• Treats all patients with dignity and respect.
• Contributes to the team effort by accomplishing delegated tasks on time.
• Understanding of different divisions under the care management department.
• Administrative duties as assigned.
• Understanding of completion of appeals and grievances.
• Additional supervisory duties according to Supervisory Role Designation.

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Job Requirements

Qualifications:
• Bachelor’s degree in healthcare-related field preferred, or equivalent combination of healthcare-related work experience and education.
• 1 year of customer service experience in a front or back medical office/organization environment preferred.
• 1 year of patient care experience, Medicare or other senior patients’ population preferred.

Skills and Requirements:
• Highly organized with proven effectiveness in time management.
• Skilled in the use of computers and multiple software systems.
• Detail-oriented and systems-thinking.
• Clinical knowledge like medical terminology, and experience with electronic health records.
• Excellent team communication skills.
• Ability to follow through with tasks as assigned.
• Work experience in a health care setting is preferred.
• Bachelor’s Degree in a health-related field is a plus.

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Job Description

Location: Novato, CA

Employment Status: Full Time

Clinical Review Specialists are responsible for reviewing patient medical records for Medicare Advantage enrollees, and other groups/populations as assigned, to identify chronic conditions to be prioritized and addressed by healthcare providers. The review process includes working with multiple electronic health records, completing of pre-appointment reviews, completing post appointment reviews and reviewing capture of chronic conditions for physician incentives.  They must maintain best practices for accurate data collection and adhere to Meritage policies and procedures.

 

Primary Responsibilities

 

• Evaluate the patient’s medical record and reports from the health plan to identify and document potential chronic conditions to be addressed by healthcare providers.
• Complete post-appointment review to assess HCC capture by providers and document findings.
• Work with team to ensure ICD10 codes submitted by physicians are supported by documentation and provide feedback to inform physician education.
• Review, assess and provide feedback to mid-level providers conducting home visits.
• Document any additional HCC codes, when clinically indicated, on the ICE file.
• Report any findings of noncompliance for issues not related to HCC in the Secondary Pursuit file.
• Collaborate with team members to research or answer any coding questions that may arise.
• Assist in education of providers and staff regarding coding procedures and policies to ensure compliance.

• Respects patients by recognizing their rights and maintaining confidentiality.

• Promotes a team approach by encouraging communication among all members of the care team.
• Contributes to the team’s effort and success by accomplishing delegated tasks on time and meeting his/her daily and weekly job goals.
• Communicate with providers regarding HCC capture via the EHR tasking system.
• Maintain excellent customer relationships with providers, medical office staff, other department staff and health plan representatives.
• Complete assigned tasks daily and in a timely manner.
• Maintain current coding credential (if applicable).
• Assist in the training and orientation of new staff as directed.

• Performs other duties and projects as assigned that support the Care Management Team and other areas, departments and programs within the Meritage organization.

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Job Requirements

• Minimum of 1-2 years current medical background with chart review experience.
• Working knowledge of medical terminology, anatomy and physiology, disease processes and pharmacology.
• Able to work effectively on an independent basis or as part of a larger work team.
• Demonstrates critical thinking skills, sound judgement and a solid sense of accountability.
• Able to concurrently use different electronic health record systems as needed.
• Detail oriented and able to work as a collaborative and positive team member.
• Strong written, verbal and listening communication skills.
• Expertise in ICD-10-CM and CPT and RAF.
• Demonstrates a professional demeanor and excellent customer services skills
• Treats others in a respectful, kind and patient manner
• Self-motivated and able to ask for assistance when needed.
• Unrestricted driver’s license and automobile insurance.
• Flexible and adaptable to change.

 

Education and Experience Requirements:

 

• High School diploma or equivalent.
• CPC certification required. CRC certification preferred
• Medical office/chart review experience.
• One year of previous recent procedural/diagnosis coding, or equivalent work experience.
• Two years of customer service experience in a healthcare related setting.
• Working knowledge in Risk Adjustment or HCC coding

 

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Job Description

Location: Novato , California

Employment Status: Full-Time

General Summary: The Care Management RN (DCE) manages defined populations by using a collaborative process of assessment, planning, implementation, and evaluation, to engage, educate, and promote/influence beneficiary decisions related to achieving and maintaining optimal health status in the Outpatient setting. The Care Management RN (DCE) uses a combination of proactive telephone calls, hospital, MD office, and home visits to beneficiaries who are enrolled in Meritage’s medical and wellness programs. This position is responsible for developing and maintaining ongoing supportive relationships with all members of the Care Management Team and beneficiaries.

Principal Accountabilities:

• Reaches out to patients identified as appropriate to provide information and education in order to deepen their understanding of their medical condition and to guide the patient in self-management of the chronic
• Emphasizes the value of health education and behavior
• Participates in all aspects of the Care Transitions
• Actively participates in the Care Team to improve/maintain positive healthcare outcomes and care
• Works in collaboration with the individual patient and his/her attending
• Supports the Primary Care Physicians and their office
• Applies the standard elements of assessment, planning, implementation, coordination, monitoring, and evaluation and will use state-of-art information
• Is highly organized, effective at managing her/his time, and is skilled in the use of computers and multiple software
• Remains objective in relationships with patients, families, and physicians and promotes a team approach by encouraging communication among all members of the care
• Coordinates care among multiple treating physicians including specialists, primary care, hospitalists, and behavioral health care, as needed
• Performs other clinical and related administrative duties as assigned to support the organization’s operational needs.

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Job Requirements

Qualifications:

• Current California RN License with no restrictions
• 5 years clinical experience, previous case/care management experience preferred
• Strong working knowledge of Electronic Health Records, Microsoft Office Suite including Excel, Outlook, Teams
• BSN preferred
• Coleman model trained is a plus.
• Direct Contracting Entity (DCE) and Accountable Care Organization (ACO) experience desired.

Requirements:

• Familiarity with data collection and methods of analyzing and reporting data, metrics, and related information pertaining to clinical health
• Professional written and verbal communication
• Ability to function effectively in a team with patients, families, physicians, MD office, and other Meritage departments and
• Treats others in a respectful, kind, and patient
• Demonstrates sound clinical judgment and critical thinking in accordance with the California Nurse Practice
• Self-motivated, able to ask for assistance, and adapts easily to
• Has a strong sense of accountability for work performed and in meeting
• Knowledgeable about the available health care and community resources for the populations
• Understanding of family dynamics and the influence of cultural and spiritual values in health care.
• Current valid driver’s license and reliable transportation with the required level of automobile liability insurance coverage.

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