Meritage Medical Network

Career Opportunities

Interested job seekers can apply by clicking on the Apply button. Please include a cover letter with salary requirements and a current resume.

 

 



Care Mangement Department Coodinator, Novato

The Care Management 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 UR Medical Director. Department administrative duties: Maintain meeting minutes and records. Mailing/ data entry for special projects. 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. 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. 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 such as 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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Credentialing Coordinator, Novato

Responsible for all aspects of the credentialing, re-credentialing and privileging processes for all medical providers in Meritage Medical Network. Responsible for ensuring providers are credentialed, appointed, and privileged with contracted health plans, and National Committee for Quality Assurance (NCQA) requirements. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications. Works to develop and maintain a streamlined, efficient and automated process for credentialing and re-credentialing. Works closely with other Meritage staff (e.g., Claims and Utilization Review department staff), to update provider agreements in the Meritage database (Quickcap). Requirements Minimum 2 years of current credentialing work experience with Health Plans, preferably in a managed care setting. Demonstrated ability to work and communicate efficiently and effectively with physicians and their staff on credentialing matters. Excellent written and verbal communications skills, including effective listening skills. Detail orientation with the ability to organize and prioritize work and manage multiple priorities with mature judgement. Ability to problem solve and research and analyze data, discrepancies and variances. Must be a self-starter with the ability to work independently with minimal supervision. Ability to establish and maintain positive working relationships with providers, management, staff, health plan representatives and other contacts outside the organization. Proficient use of electronic Provider Databases and Microsoft Office applications such as Word, Excel, Outlook and Power Point. Bachelor’s degree or equivalent combination of health care experience and education. National Association Medical Staff Services (NAMSS), Certified Provider Credentialing Specialist (CPCS) preferred.

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ACO Care Manager, Novato

Care Managers focus on wellness, prevention, and efficient care through the coordination with their patients, their patient's families and their physicians. Plan and coordinate health care services appropriate to achieve the goal of medical rehabilitation. Assistance in the development, implementation and coordination of a medical care plan with health care providers, as well as the patient and their family. Evaluation of treatment results and adjustment of care plans as needed. Evaluation of medical conditions; collaborates with the treating physician in the development and implementation of an individual plan of care. Beneficiary education to deepen their understanding of their medical conditions and to guide self- management. Coordination of medical resources. Communication of healthcare needs to the individual and the care team. Monitoring and reporting an individual's progress toward goals. Promotes cost-effectiveness and self- care. Professional Competencies: Highly organized, effective at time management, skilled in the use of computers and multiple software systems. Working knowledge of effective utilization, quality of care and service. Excellent team communication and presentation skills. Remains objective 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. Ability to translate Evidence Based Medicine Care Guides into Individual Care Plans. Qualifications: Current CA RN License Valid CA Driver's license Experience with senior populations and Medicare a strong plus. 2-3 years of Case Management experience preferred.

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Wellness Nurse Practitioner, Novato

Excellent Full-Time career opportunity to join a dynamic care management team. Under supervision and in collaboration with the overseeing physician, performs annual wellness visits for a geriatric population in their homes, including assessments of chronic conditions and preventative care. Performs occasional follow-up exams as directed/warranted. Educates patients regarding health promotion/illness prevention. Documents thoroughly with attention to detail utilizing the electronic record and templates. Requires: Current CA RN and NP licensure; CPR certification; current and unrestricted Driver’s License and car insurance; BSN, MSN preferred; Minimum 3 years current outpatient NP experience, primary care emphasis preferred.

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Director of Contracting, Novato

We have a current full-time career opportunity for a seasoned senior healthcare contracting director to handle all healthplan contract negotiations and administration (HMO, PPO and ancillary contracts), payer relationships, and associated programs (e.g. Pay for Performance), for the purpose of strategically positioning the company with payers and optimizing revenue. This position is responsible for ensuring all contract requirements are met, maintained and communicated appropriately to all appropriate parties. The director is also responsible for contract negotiations with all partner hospitals, ensuring strong and effective relationships are cultivated and maintained. In addition, the director is the primary negotiator for physician/provider contracting, ensuring primary care contracts are maintained and leads specialty contracts (e.g. capitated, case rate, FFS). This position also coordinates directly with Utilization Management to ensure a complete network of service offerings and contracts with non-network providers when necessary. Requirements: A Bachelor’s Degree, Master’s preferred, in a related business field with a minimum of 7 years current healthcare contracting, with a strong emphasis on direct health plan negotiations as well as a demonstrated ability to successfully communicate and negotiate directly with physicians. Experience with dual risk contracts as well as hospital partnerships preferred. Excellent negotiation skills, leadership abilities, attention to detail, and effective written and verbal communications are a must. In addition, strong data analytical and organizational skills are strongly preferred.

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