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.

 

 



Clinical Data Analyst, Novato

This position gathers, researches and analyzes clinical and claims data for the Meritage Medical Network as compared to industry benchmarks in order to identify, understand and compare best and current practices and trends in clinical quality and Risk Adjustment. These include areas such as: Clinical Quality improvement: Identify areas of opportunity to increase adherence to quality metrics by individual providers and the overall network. Identify practices of high performing organizations for potential adoption. Population health management: Coordinate strategies and efforts. Medical coding: Identify opportunities for improvement among the Meritage coding team and provider office coding practices. The analyst will present data, findings and recommendations to leadership, medical directors and identified committees (e.g., QA) in order to support desired changes, outcomes and goals. This individual reports to the Quality Manager and works with other members of the Quality Management team and interdepartmentally as required. Skill/Knowledge Requirements Demonstrated knowledge of concepts, practices, and procedures used within an analysis and/or managed care, healthcare environment. E.g. P4P, RAF, 5Star, Population Health Demonstrated skills in analytics tools and software in environments that are most applicable to the project requirements, including but not limited or exclusive to: db (SQL, Access); FTP scripting; Crystal Reports, etc. Experience working with and understanding of the architecture of an Electronic Health Record and related operating systems.

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Clinical Review Specialist, Novato

Clinical Review Specialists are responsible for reviewing patient medical records for Medicare Advantage enrollees 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. 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 QUALIFICATIONS: Coding certification is required. Medical background/ chart review experience Knowledge about medical terminology, anatomy and physiology, disease processes and pharmacology

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IT Project Manager, Novato

This position functions as a focal point for the evaluation, selection, and implementation of information management products, technology and services. The Project Manager is responsible for managing and controlling the development and implementation process for information management projects. Working closely with the client and members of the IT team, the Project Manager also performs services to re-engineer processes to assist departments to better utilize existing systems and/or to select, prepare, and implement new system solutions. This position may also operate as the project manager for installation and implementation of new features/functions, as well as, support functions and features of the product/system. Utilizes recommended and supported processes, standards, and tools to manage projects from inception through implementation to post implementation review and service and support transition. Ensures that projects are well planned, maintained, and communicated. Manages and is accountable for funded projects to ensure projects are completed within budgetary guidelines. Partners with clients, technical staff, and management to effect successful projects. Provides, facilitates timely and effective transition of completed projects to client department staff and ITS support staff incorporating all necessary and appropriate technical and operational documentation Qualifications Bachelor of Arts or Science or equivalent desirable Project Management Institute (PMI) certification or equivalent desirable 5 – 8 years progressively complex information systems experience 3 - 5 years information systems project management experience Minimum of 3 years healthcare and/or managed care industry experience Business case development Systems/Process analysis

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Lead Software Developer/Analyst, Novato

The Lead, Software Developer/Analyst position is responsible for leading and mentoring a small team of on-site and remote employed and contracted Developer/Analysts. The Lead role takes an active role in customer relationship building, service delivery, and vendor management. The Lead role is responsible for leading and performing reporting and analysis of healthcare/managed care information, obtained from a variety of sources, including administrative, clinical, financial, and demographic data. The position develops and/or supports software applications, tools and/or analytic processes. Analyzes software applications and business data to ensure accurate findings and applicable recommendations for development and/or operations. Minimum 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 software development and/or analysis environment, with 4 of those years within a healthcare related and/or managed healthcare setting strongly preferred. Experience in leading, coaching, mentoring remote and on-site, employed and contracted, staff.Previous experience in the analysis, development, support, maintenance and training of a software developed systems required. Demonstrated advanced skills in developing software in environments that are most applicable to the project requirements, including but not limited to: Web (HTML, AngularJS, CSS, JavaScript, , etc.); db (SQL, Access); Desktop (.Net, C#, VB, etc.); FTP scripting; Crystal Reports, etc. Strong computer skills using MS Outlook, Excel, Word, PowerPoint, and Visio. Experience using applications for project and task/resource management and collaboration (e.g., Asana, SharePoint, Project, Jira) a plus.

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Network Relations Intern, Novato

The Network Relations Intern provides administrative support to the Network Relations Department. Sets up and maintains network department databases, files and records. Assists with coordinating quarterly network-wide newsletters and ad hoc communications with the provider offices. Maintains a sound and comprehensive understanding of the Network Relations department and staff in order to assist internal customers to the department with service and information requests. Maintains a solid understanding of the Meritage Medical Network organization, services and staff and how such services and personnel support network physicians and practices. Receives and distributes incoming department mail. Assists with the development of physician and office staff information and education materials for distribution in the field. Assists with the coordination of the Network Quarterly newsletter. Assists with maintaining associated records and databases. As needed, assists with the credentialing and re-credentialing of network providers. Performs other duties as assigned Minimum Requirements and Competencies: Excellent customer services skills with a demonstrated genuine and friendly demeanor. Strong written and verbal communications skills. Strong organization skills with a detail orientation. Ability to multi-task and meet deadlines and agreed upon deliverables. 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. 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. 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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PT or Per Diem Wellness NP/PA, Novato

Under supervision from the overseeing Medical Director, the Wellness NP/PA performs annual wellness visits for a primarily geriatric population, including assessments of chronic conditions and preventative care and educates patients regarding health promotion and illness prevention. Requirements Current CA RN and NP or PA licensure; CPR certification A minimum of 3 years current outpatient NP primary care experience is preferred. Current and unrestricted Driver’s License and car insurance; this job requires travel time to beneficiary homes- mileage is reimbursed by Meritage.

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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. Must possess a collaborative and proactive work style with a strong commitment to excellence, quality, efficiency, fiscal responsibility and personal accountability.

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UM Manager, Novato

In collaboration with the Chief Medical Officer and Medical Director, the UM Manager develops, manages and directs the organization’s Utilization Management department to assure compliance with all health plan and government requirements and is responsible to ensure the organization passes all required audits, including HEDIS and NCQA. Provide overall direction, design, implementation, and monitoring of utilization programs to meet the organization’s utilization goals while maintaining customer satisfaction Provide overall supervision and guidance to clinical RN and administrative UM staff. Develop and implement the annual Utilization Management Program and work plan. Oversee the daily utilization management activities, including referrals and authorizations, concurrent inpatient reviews, and compliance with all required regulations and contractual obligations. Develop guidelines for appropriate patient referrals to Complex Care Management. Work in collaboration with partner hospitals to develop policies to ensure appropriate repatriation of members from out of network facilities RN required, BSN a plus, Bachelor’s degree in healthcare related discipline highly desired. Excellent leadership, interpersonal, collaboration and communication skills. Proficiency in the area of developing, managing, and reporting clinical and business analytics and metrics. Knowledge and experience using Lean Six Sigma concepts and tools highly desirable. 3 + years of current related leadership in Managed Care required. Experience in quality, discharge planning, utilization management, home care, and complex care management preferred.

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