Job Description

Location: Novato

Employment Status: Full-Time

General Summary

Supervises the Care Management staff in serving defined populations by using a collaborative process of assessment, planning, implementation and evaluation, to engage, educate, and influence beneficiary decisions related to achieving and maintaining optimal health status. Responsible for assessing department work volume and appropriately assigning daily work to staff; and, assessing, coordinating and handling complex patient cases and admissions. Responsible for departmental quality assurance functions, assessing activities, developing and analyzing reports, and assigning staff to ensure quality care and cost containment. Responsible for department audits and developing, maintaining and reporting department productivity and outcomes reports, metrics and measures. This is a working nurse supervisor role, with approximately 70% of time spent serving as department supervisor and 30% of the time as a Care Manager.

Principal Accountabilities

• Coaches assigned staff and, as required, reaches out to identified individuals and provides information and education to deepen their understanding of their medical condition and to guide the patient in self- management of the chronic disease.
• Emphasizes the value of health education, life style choices and behavior modification.
• Participates in all aspects of the Care Transitions Program.
• Actively participates in the Care Team to improve/maintain positive healthcare outcomes and care transitions.
• Works in collaboration with the individual patient and his/her attending physician.
• Supports the Primary Care Physicians and their office staffs towards quality and effective care of patients.
• Applies the standard elements of assessment, planning, implementation, coordination, monitoring and evaluation, using available information tools, measures, metrics and benchmarks.
• Is highly organized, effective at managing her/his time, and is skilled in the use of computers and multiple software systems and applications.
• Remains objective and compassionate in relationships with patients, families and physicians and promotes a team approach by encouraging communication among all members of the care team.
• Coordinates care among multiple treating physicians including specialists, primary care, hospitalists and behavioral health care, as necessary.
• Responsible for ensuring that department staff and operations are in compliance with all business partner agreements, i.e., Payor contracts, and applicable State and Federal agency, regulatory and legal requirements.
• Carries out departmental audits and reviews as are required for various Payor agreements, internal review committees, and State and Federal agencies.
• Consistently demonstrates behaviors and a workstyle that models integrity, accountability and respect for others.
• Responsible for monitoring, tracking, and approving timekeeping for assigned staff to ensure that department staffing levels are sufficient to meet department and work volume needs and requirements.
• Works with the department managers on, and is responsible for, staff hiring, development, performance improvement and assessments, disciplinary actions and, if warranted, termination.
• 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 and a minimum of 5 years clinical and care management work experience, including supervision of staff.
• Bachelor of Science Degree, Nursing.
• Advanced computer skills including Word, Excel, and Outlook; ability to develop, run and analyze reports and key metrics; and, comfort and familiarity working with numerous electronic health record systems.

Requirements

• Knowledge of data collection and methods of analyzing, trending and reporting data, key metrics and work outcomes.
• Professional written and verbal communication skills.
• Ability to function in a team with patients, families, physicians, MD office and staff and leadership from within Meritage.
• Demonstrates sound clinical judgment and critical thinking in accordance with the California Nurse Practice Act.
• Self-motivated, able to ask for assistance and adapt easily to change.
• Knowledgeable about the available health care and community resources for the populations managed.
• Understanding of family dynamics and the influence of cultural and spiritual values in health care.
• Positive, proactive and effective management and leadership skills and abilities.
• Current valid driver’s license and reliable transportation with required level of automobile liability insurance coverage.

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Job Description

Location: Novato

Employment Status: Full-Time

Position Summary
The Quality Department Coordinator is 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 director of care management, the Risk Adjustment Medical Director and the UM Medical Director.

Department administrative duties:
• Maintain meeting minutes and records
• Work with the Quality Manager to plan and schedule staff meetings
• Mailings and data entry for special projects.
• Appeals- work with the Utilization Review care management team to complete appeals
• Grievances- work with the director of care management and senior medical director to review and track grievances for quality reporting
• Assist any member of the Care Management department staff as needed

Principal Accountabilities
• Respects patients by recognizing their rights; maintaining 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

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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 senior patients’ population preferred.

Skills and Requirements:
• Highly organized with proven effectiveness at 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 preferred.
• Bachelor’s Degree in a health-related field a plus.

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Job Description

Location: Novato

Employment Status: Full-Time

Position Summary
As a key member of the Network Relations Department, serves as the primary point of contact for all incoming calls and inquiries to the department. Provides administrative support to the Network Liaisons while they are out in the field visiting provider offices or are otherwise occupied with meetings and events. Assists with coordinating quarterly physician and network-wide newsletters and ad hoc communications with the provider offices. Assists with the coordination of Network events and meetings. Sets up and maintains network department databases, files and records.

Duties and Responsibilities
1. Maintains a sound and comprehensive understanding of the Network Relations department and staff in order to assist internal and external customers to the department with service and information requests.
2. Maintains a solid understanding of the Meritage Medical Network organization, services and staff and how such services and personnel support network physicians and practices.
3. Answers department telephones, responds to general inquiries, takes messages and refers calls/inquiries to the appropriate Network Liaison, and/or refers calls as necessary to other Meritage staff/departments.
4. Assists with the development of physician and office staff information and education materials for distribution in the field, including the Network Quarterly newsletter, to physician practices.
5. Assists with the preparation and coordination of network physician social events such as the annual mixer as well as Practice Manager social events.
6. Assists with the coordination of Regional Operations Committees and Membership Committee meetings, including but not limited to developing and maintaining committee lists, developing and sending out invitations, save the date reminders, reserving
meeting locations, meal coordination, developing and disseminating meeting agendas and materials, and maintaining associated records and databases.
7. Responsible for all aspects of credentialing/re-credentialing providers, to include but not limited to verification of application/documents, mailing of requests for consideration, initial applications, approval, denial, termination letters, tracking
license and certification expiration for providers, and accurately loading/maintaining provider information into the Credentialing database.
8. Performs other duties as assigned related to supporting the Network Relations Department and the overall Meritage organization.

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Job Requirements

Minimum Requirements and Competencies
1. Excellent customer services skills with a demonstrated genuine and friendly demeanor.
2. Strong written and verbal communications skills.
3. Detail orientation with the ability to organize and prioritize work and manage multiple priorities with mature judgement.
4. Ability to multi-task and meet deadlines and agreed upon deliverables.
5. Ability to problem solve and research and analyze data, discrepancies and variances.
6. Professional comportment and work style that projects a confident, open, capable and trustworthy persona that is able to be sustained and maintained in all initial and subsequent interactions with customers.
7. Must possess strong listening skills with the ability to make customers feel as though they have been heard and that their input, concerns and suggestions are valued and will be taken seriously.
8. Demonstrated ability to work and communicate efficiently and effectively with physicians and their staff on credentialing matters.
9. Must be a self-starter with the ability to work independently with minimal supervision.
10. Working knowledge and experience with office based computer equipment and systems including but not limited to: Word, Excel, PowerPoint, Outlook, Adobe and Publisher.

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Job Description

Location: Core PT-San Rafael

Employment Status: Full Time

General Summary
This administrative physical therapy staff position is a combined position that incorporates both “front” office and “back” office (P.T. Aide) roles and responsibilities. Prior PT office experience is preferred but we are willing to train the right candidate.
• Greet patients, check them in for appointments, answer general questions, issue paperwork and assist with completion if indicated; notify physical therapists of each patient’s arrival.
• Answer phones, log all patient issues into electronic documentation system as they occur.
• Verify insurance eligibility and independently clarify questions/obtain answers from insurance plan representatives.
• Determine and collect correct co-payment amounts. Enter billing charges into system.
• Schedule new patient and follow up appointments.
• Enter authorization requests for continued physical therapy
Physical Therapy Aide Duties
• Help maintain lobby, and treatment areas.
• Change linens in rooms between patients as therapists don’t use sheets with every patient.
• Assist patients with set up and on/off gym equipment as directed by physical therapist.
• Perform ultrasound, light therapy treatments as directed by physical therapist.
• Set up/remove patients from other modalities. Set timers and check on patients as needed.
• Set up treatment rooms in preparation for specific patients.
• Act as a stand-by assist for physical therapist during client treatments as needed.
• Monitor treatment timers.
• Other duties as required.

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Job Requirements

Qualifications
• Prior work experience as a Receptionist, Medical Office or similar role
• Working knowledge of medical office software/EHR. Proficiency in Microsoft Office Suite with accurate keyboarding skills
• Hands-on experience with office equipment (e.g. fax machines and printers)
• Professional attitude and appearance
• Solid written and verbal communication skills
• Ability to be resourceful and proactive when issues arise
• Excellent organizational skills
• Multitasking and time-management skills, with the ability to prioritize tasks
• Customer service attitude

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Job Description

Location: Novato

Employment Status: Full Time

Clinical Review Specialists are responsible for reviewing patient medical records to identify chronic conditions to be prioritized and addressed by healthcare providers. The review process includes working with multiple electronic health records, completing both pre and 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.

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 Hierarchical Condition Category (HCC) capture by providers and document findings.

Work with team to ensure ICD10 codes submitted by physicians are supported by documentation. Provide feedback to inform physician education.
Collaborate with team members to research or answer any coding questions that may arise.

Travel to Network Member offices to assist in education of providers and staff regarding coding procedures and policies and to ensure compliance with HCC capture. The Clinical Review Specialist may stay embedded with a network member’s office for an extended period of time.

Maintain excellent customer relationships with providers, medical office staff and health plan representatives.

Complete assigned daily tasks in a timely manner- all tasks are time sensitive

Participate in audits required by each health plan by finding chart notes in different EHR systems and sending to plans on appropriate due date.

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Job Requirements

Education and Experience
Graduate of an accredited coding program or Medical Assistant program. Certified Coder highly desirable.
Familiarity with HCC codes and Risk Adjustment Factor (RAF) model preferred.
High School diploma or equivalent
Ability to multi-task and address competing priorities.

Qualifications
Medical background/ chart review experience required.
Working knowledge of medical terminology. Familiarity with anatomy and physiology, disease processes and pharmacology highly desirable.
Able to use different electronic health record systems as needed.
Detailed oriented and able to work as a collaborative and positive team member.
Strong written and verbal communication skills
Comfortable using Microsoft Excel
A valid California Driver License and proof of insurance required.

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Job Description

Location: Novato

Employment Status: Full Time

General Summary

This position coordinates utilization review and case management activities for commercial and Medicare enrollees.  The Utilization Management nurse is knowledgeable about the Nurse Practice Act, NCQA, Millman Care Guides, and the Center for Medicare and Medicaid, HMO timeliness rules and pertinent state and federal regulations.

• Review routine referral/service requests on assigned patients in accordance with NCQA timeliness standards and health plan benefit structure.
• Prepares and presents cases for medical director review in a concise, objective and organized manner.
• Assists with identifying patterns and trends and develops and implements corrective actions when necessary.
• Educates and supports members in the accessing care using their HMO and Medicare Advantage benefits as needed.
• Review routine referral/service requests on assigned patients in accordance with NCQA timeliness standards and health plan benefit structure.
• Identifies and refers patients to disease management, wellness programs and community resources whenever relevant.
• Assesses members’ physical, psychological, social, environmental, financial and functional status as necessary and informs the patient’s treating physician of clinically relevant findings e.g. positive score of depression screening, non-compliance with the plan of care and barriers t treatment.
• Collaborates with the concurrent review.

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Job Requirements

Qualifications

Education: 

• Current California RN License with no restrictions
• BSN Preferred

Experience:   

• Minimum five years of clinical experience.

• Experience strongly preferred in one or more of the following: HMO, Health plan, Medicare, Utilization Management, Case Management

Knowledge, Skills, and Competencies

• Ability to understand and facilitate communication among team members, patients, families, physicians and medical office staff.
• Ability to communicate effectively with contracted health plans and meet required turn around times
• Good clinical judgment, critical thinking skills and independent problem resolution
• Ability to organize and prioritize workload
• Good working knowledge of Microsoft Office, Outlook, EHR, prior Health Care Management/authorization software.

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Job Description

Location: Novato

Employment Status: Fulltime

Business Intelligence (BI) Analyst, Lead

The Business Intelligence (BI) Analyst, Lead develops and supports the transformation of data into information to provide actionable insights to enhance and expand the quality, efficiency, and cost effectiveness of products and services provided by Meritage Medical Network to its members, physicians, health plans, and staff.

The BI Analyst Lead utilizes established data sources within SQL, Access databases, Excel tables and Power BI  to collect, integrate, extract, analyze and present information in reports, dashboards, and key data visualizations. The BI Analyst Lead, under direction of the IT Director, provides analytics staff work distribution, peer review, and coaching.

The preferred candidate demonstrates advanced SQL, Access, Excel and Power BI skills to create data views, reports, extracts, and visualizations within a healthcare managed care environment.

Essential Job Functions

Ability to transform data into actionable and tailored information visualizations designed for specific issues, operational and/or executive decisions and insights.

Regularly applies conceptual knowledge, analytical methods, and problem solving skills to perform assignments and improve efficiencies within existing systems, processes, functions, and applications.

Provides IT solutions and services which ultimately contribute to physician efficiency, productivity, quality, and organizational clinical, operational, and financial performance.

Advanced analytical and problem solving skills.

Determines operational feasibility by evaluating analysis, problem definition, requirements collection, solution development, and proposed solutions.

Documents and demonstrates solutions by developing documentation, flowcharts, layouts, diagrams, charts, code comments, clear code and appropriate metrics.

Project management training & skills to organize, document, monitor, manage, and communicate project status, issues, risks and associated mitigations and/or resolutions.

Prepares and installs solutions by determining and designing system specifications, standards, and programming.

Improves operations by conducting complex systems analysis, tracking metrics, recommending changes in processes, policies and procedures.

Develops advanced solutions by studying information needs; conferring with users; studying systems/data flow; data usage, and work processes; investigates problem areas; follows industry standard/best practice for software development life cycle.

Ability to be flexible in an environment of changing priorities and work both independently and in a team.

Self-motivated with the ability to prioritize, meet deadlines, and manage changing priorities.

Key Responsibilities

Works closely with end users to understand their business needs in relation to software functionality.

Analyzes software problems and business data requiring complex methods to ensure accurate findings and applicable recommendations.

Designs, delivers, and improves software applications training programs and related courseware.

Understands the end users’ business needs, works closely with them to provide solutions, and aligns end user business needs with high levels of application functionality.

Provides technical support to less experienced information systems analysts.

May serve as a liaison between vendors, IT, and internal customer to ensure service delivery agreements are met and that return on investment is realized.

Updates job knowledge by studying state-of-the-art analysis, visualization, and development tools, programming techniques ;participates in educational opportunities; reads professional and technical publications; maintains personal networks; participates in professional organizations

Complies with MMN’s Policies/Procedures protecting patient information and the confidentiality of the information in accordance with the Federal and State regulations.

 

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Job Requirements

• Bachelor’s degree in related healthcare, business, computer science, information sciences, software development/analysis or related field preferred; experience or alternative degree or alternative knowledge acquisition may be considered in lieu of education.
• Minimum of 6 years of experience within a data analysis environment, with 4 of those years preferably within a healthcare related and/or managed healthcare setting preferred; alternative experience acquisition or a combination may be considered in lieu of required experience.
• Demonstrated knowledge of concepts, practices, processes and procedures used specifically within a managed healthcare environment.
• Previous experience in the analysis, development, support, maintenance and training of a OTF and developed systems required.
• Demonstrated advanced skills in developing solutions in environments that are most applicable to the project requirements, including but not limited or exclusive to: Database (SQL, Access); Spreadsheets (MS Excel); Data Visualization (Microsoft Power BI); FTP scripting; Crystal Reports;  a plus to have:  Web (HTML, CSS, JavaScript, AngularJS, etc.); Desktop (.Net, C#, VB, etc.); etc.
• Strong skills using MS Office 365 – Outlook, Access, Excel, Word, PowerPoint, Skype, Teams, and Visio.
• Familiarity with specialty applications for project and resource collaboration (e.g., SharePoint, Asana, MS Teams)

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