MedPOINT Careers

MedPOINT has the following job openings. Please click on the job title for more information.

Grievance Clerk (Post Date: 5/19/17)

MedPOINT, a large MSO in the San Fernando Valley offers competitive salaries and benefits in a collaborative working environment. For immediate consideration of this position, please e-mail your resume and salary requirements to personnel@medpointmanagement.com

Summary:

Provide administrative support to the Grievance Department including setting up initial cases in the grievance.

Duties and Responsibilities:

  1. Input newly received grievances and appeals in the sPHERICAL Solutions database
  2. Work directly with Grievance Supervisor to make staff assignments based on established rotation protocol
  3. Make follow-up calls to provider offices to request case information as directed by grievance coordinator
  4. Scan cases into sPHERICAL database and associated network drive
  5. Handle departmental faxing
  6. Answer and direct department phone calls
  7. Take and distribute messages to grievance coordinators
  8. Check and distribute documents and correspondence
  9. Maintain file systems
  10. Prepare and send outgoing mailings and packages
  11. Type requested documents and correspondence
  12. Monitor and order inventory of office supplies for department
  13. Run daily, weekly and monthly reports as directed by Grievance Supervisor

Minimum Job Requirements:

  • High School graduate or GED equivalent

Knowledge, Skills and Abilities Required:

  • Good organizational skills
  • Good attention to detail and accuracy
  • Time management skills
  • Adaptable and flexible
  • Minimum or higher proficiency level with Microsoft Office Programs; primarily Word and Excel 2013 or higher
  • EZ-CAP® knowledge a plus.
Grievance Coordinator (Post Date: 5/19/17)

MedPOINT, a large MSO in the San Fernando Valley offers competitive salaries and benefits in a collaborative working environment. For immediate consideration of this position, please e-mail your resume and salary requirements to personnel@medpointmanagement.com

Summary:

Receive, review, investigate and resolve member grievances and appeals that are received from IPA contracted health plans. The position will require resolution of the grievance issues in compliance with legal and regulatory requirements.

Duties and Responsibilities:

  1. Receive appeals and grievances form the health plans and set up the case in sPHERICAL Solutions (Grievance/ Appeal Internal Database)
  2. Collects, organizes and tracks information to facilitate and expedite processing of grievances and appeals from a variety of internal and external sources including MPM departments, provider PCP offices, provider specialty offices and ancillary providers
  3. Tracks receipt of information and performs telephonic, e-mail and faxing follow-up
  4. Writes letters to health plan summarizing all findings, recommendations and corrective action requirements
  5. Submits information package along with all medical records, provider letters and MPM summary letter to health plan within requisite time frame (generally 3-7 working days, depending on health plan for standard grievances; 1-3 day times period for expedited grievance requests)
  6. Records all transactions in sPHERICAL Solutions database
  7. Completes case in sPHERICAL Solutions
  8. Closes out case in sPHERICAL Solutions when final letter is received from the health plans
  9. All other grievance and appeals related functions, upon request

Minimum Job Requirements:

  • High School graduate or GED equivalent; Bachelor’s degree in health care related field (preferred)

Knowledge, Skills and Abilities Required:

  • Effective verbal and written communication skills and effective interpersonal skills.
  • Positive and approachable demeanor
  • Knowledge of medical terminology preferred
  • Ability to work well in a fast paced environment and have multi-tasking skills
  • Able to stay focused on the telephone even with noise and other distractions
  • Minimum or higher proficiency level with Microsoft Office Programs; primarily Word and Excel 2013 or higher
  • EZ-CAP® knowledge a plus.
Supervisor, Member Services (Post Date: 5/19/17)

MedPOINT, a large MSO in the San Fernando Valley offers competitive salaries and benefits in a collaborative working environment. For immediate consideration of this position, please e-mail your resume and salary requirements to personnel@medpointmanagement.com

Summary:

The Member Services Supervisor is responsible for directing Member Services functions. The position is responsible for administering departmental as well as corporate policies. The supervisor’s primary responsibility is leading the Member Services team in achieving production goals and to perform other responsibilities.

Duties and Responsibilities:

  • Assist member service representatives to investigate member issues and identify solutions
  • Addresses more complex member inquiries, questions and concerns in all areas including benefit interpretation and referrals/authorizations for medical care
  • Receives, responds to and directs member phone calls
  • Hire and ensures effective training of member services agents
  • Provide scripts to assist with phone intake
  • Ongoing monitoring and QA
  • Performs evaluations and any disciplinary actions of member services representatives
  • Resolve complaints and other issues
  • Keep current with new client information and services offered
  • Isolate and identify areas of improvement
  • Manage and report on phone queues
  • Work with management on member service initiatives
  • Assist with logging calls in sPHERICAL (member services database)
  • Educate team on newly established policies and procedures
  • Complete special projects

Minimum Job Requirements:

  • High School graduate or GED equivalent
  • 5-8 years of related experience

Knowledge, Skills and Abilities Required:

  • Good organizational skills
  • Good attention to detail and accuracy
  • Time management skills
  • Adaptable and flexible
  • Minimum or higher proficiency level with Microsoft Office Programs; primarily Word and Excel 2013 or higher
  • EZ-CAP® knowledge a plus
  • Relies on extensive experience and judgment to plan and accomplish goals
  • Wide variety of creativity and latitude is expected
Member Outreach Representative (Post Date: 5/19/17)

MedPOINT, a large MSO in the San Fernando Valley offers competitive salaries and benefits in a collaborative working environment. For immediate consideration of this position, please e-mail your resume and salary requirements to personnel@medpointmanagement.com

Summary:

Responsible for engaging members to schedule appointments for preventive care and chronic care services. Representatives will also be responsible for logging calls and creating reports as needed to show scheduling progress.

Duties and Responsibilities:

  1. Use member gap reports to call members and encourage him/her to schedule preventive care and chronic care services to meet HEDIS/STARs requirements
  2. Work with specialists, PCPs and ancillary providers to assist with scheduling members for above services
  3. Contact members to encourage completion of annual member satisfaction surveys
  4. Log outbound and inbound calls into sPHERICAL member outreach module
  5. Create reports on a weekly and monthly schedule to show scheduling progress
  6. Collaborate on innovative programs to more fully engage members and improve participation in these areas
  7. Assist HEDIS/STARs quality coordinators on special projects
  8. Collaborate on scripting for member outreach phone calls
  9. Additional projects in the Quality Management department as required

Minimum Job Requirements:

  • High School graduate or GED equivalent
  • One year experience working in a call center environment; health care environment preferred
  • Ability to work varying shifts if requested to assist in increasing patient outreach

Knowledge, Skills and Abilities Required:

  • Effective verbal and written communication skills and effective interpersonal skills.
  • Ability to work well in a busy department
  • Able to stay focused on the telephone even with noise and other distractions
  • Bilingual (Spanish and English) preferred
  • Minimum or higher proficiency level with Microsoft Office Programs; primarily Word and Excel 2013 or higher
  • EZ-CAP® knowledge a plus.
Network Management Support Team – Provider Services (Posted: 05/19/17)

MedPOINT Management (MPM), a large MSO in the San Fernando Valley, offers competitive salaries and benefits in a collaborative working environment.  For immediate consideration of this position, please e-mail your resume and salary requirements to personnel@medpointmanagement.com

Summary:

Responsible for analyzing new provider credentialing applications (CPPA), uploading provider information into EZ-CAP®, and forwarding CPPA to the Credentialing Department.  Prepares notifications of new providers to the Health Plans and sends out welcome packages to Providers.  Prepares all documents for scanning as back up into Laserfiche.  Overtime, having a breadth of knowledge about the company as a whole to be able to answer calls and assist with Provider support.  Works under the supervision of the VP, Network Operations, Manager and Supervisor of Provider Services.

Duties and Responsibilities:

  1. Maintain Provider Demographic Matrices
  2. Phone/email correspondence with Providers/Clinics/Health Plans
  3. Support “Demographic Updates” (database/system updates)
  4. LaserFiche scanning preparation
  5. Health Plan request for missing documentation via e-mail

Minimum Job Requirements:

High school diploma or GED Knowledge of medical management/managed care a plus, not required.

Knowledge, Skills, and Abilities Required:

  • Strong written and oral communication skills
  • Ability to analyze, interpret and prepare reports
  • Proficiency with Microsoft Office Programs; primarily Word and Excel 2013 or higher
  • EZ-CAP® knowledge, a plus
AP Specialist (Posted: 05/19/17)

MedPOINT, a large MSO in the San Fernando Valley offers competitive salaries and benefits in a collaborative working environment. For immediate consideration of this position, please e-mail your resume and salary requirements to personnel@medpointmanagement.com

Summary:

The successful candidate will be responsible for full cycle accounts payable processing.  This candidate will validate, process, and ensure timely payment of invoices, check requests, and expense reports.  The candidate will utilize MAS200, EZCAP 6.0, Outlook, and Excel on a daily basis.  The candidate must be organized, detail-oriented and self-motivated.  The candidate must possess good oral and written communication skills.  The candidate will assist the Accounts Payable Supervisor in implementing process improvement.  The candidate is required to preserve the confidentiality of any information that flows into the department and into the company as well as all information protected by HIPAA.

Duties and Responsibilities:

  1. Act as primary contact with vendors and clients such as answer inquiries from vendors, suppliers, and employees, and research discrepancies.
  2. Analyze, prioritize, review, and audit invoices, expense reports, and check requests. Obtain required vendor approvals and ensure proper coding.
  3. Maintain a timely and accurate entry in recording transactions and payment of the Company’s obligations through the Sage MAS200 and EZ-CAP 6.0 software.
  4. Processing may involve utilization of website downloads of invoices/statements in Excel or PDF format. Setup and schedule ACH payments as required.
  5. Responsible for positive pay, weekly check stock inventory, and upload of payment backup in Sage MAS200.
  6. Review and properly age invoices utilizing Aged Trial Balance.
  7. Periodically review stale-dated checks and ensure proper disposition.
  8. Reconcile vendor statements, and maintain files for accounts.
  9. Assist in monthly closing and special projects as needed including monitoring any recurring charges, as well as, performing any A/P reclassifications necessary for the proper matching of expenses by period.
  10. Maintain accurate information concerning Company’s 1099 Policy and handle all 1099 reporting activity at year-end.
  11. Complete additional assignments and projects as required by the Accounts Payable Supervisor, Finance Manager, Controller, and CFO or other administrative team members.

 Minimum Job Requirements: 

  • AA degree or an equivalent combination of education, training, and experience is required. Minimum 3 years of experience with accounts payable processing.  Intermediate to Advanced Excel skills required.  MAS200 and EZ-CAP® knowledge a

Knowledge, Skills and Abilities Required:

  • Strong organizational, analytical and oral/ written communication (English) skills required.
  • Intermediate to Advance level in MS-Excel 2013 or
  • Proficiency in MS Office and PC skills required.
  • Ability to perform multiple tasks while maintaining productivity and quality standards.
  • Ability to work well with others in a professional, team-oriented
  • Must be able to perform independently according to departmental standards with little supervision.
Denial Clerk (Posted: 05/19/17)

MedPOINT, a large MSO in the San Fernando Valley offers competitive salaries and benefits in a collaborative working environment. For immediate consideration of this position, please e-mail your resume and salary requirements to personnel@medpointmanagement.com

Summary:

The denial coordinator is responsible for preparing and processing denial notifications for managed care members. Must have knowledge of healthcare, medical terminology and managed care.  Must be proficient in MS Office programs (i.e., Word, Excel). Good communication skills for speaking with health plans, provider’s offices and members. Needs to have the ability to multi-task and prioritize. The denial coordinator must be able to handle these responsibilities with confidentiality.

Duties and Responsibilities:

  1. Reviews authorizations as they come in.
  2. Check all notes for medical necessity or benefit coverage
  3. Check previous authorizations, claims and notes, back history etc.
  4. Type the appropriate letter according to health plan and product line (Medi-Cal, Commercial, Medicare, Medi-Medi, Cal MediConnect and CCS) in English and threshold language if necessary.
  5. Verify that the proper criteria are stated for the denial/modification using each health plan’s E.O.C. and/or Medi-Cal, CMS matrixes for benefit denials and denial matrix for medical necessity denials.
  6. Enter in notes section that it was denied/modified and enter reason from the letter
  7. Fax denial letter to requesting and/or requested physician and mail copy of letter in appropriate language to member.
  8. Fax copy of denial letters in both languages, confirmation from physician’s office along with our medical review form, and notes to health plans.

Minimum Job Requirements:

High school graduate.

Knowledge, Skills and Abilities Required:

  • One year medical office experience.
  • Completion of medical terminology class.
  • Denial process knowledge.
  • One year UM experience.
Contract Specialist (Posted: 04/07/17)

Large, fast paced MSO in Woodland Hills is seeking a Contract Specialist.

In addition to Managed Care contracting experience, familiarity with Medi-Cal 2 plan model is a plus. Must have health care experience, be computer literate and have knowledge of Microsoft Office.

The ideal candidate will have excellent oral and written communication skills. We are willing to train the right candidate. Our company offers a full range of benefits, and a salary package commensurate with experience.

Please send resume to personnel@medpointmanagement.com or fax to (818) 702-9128.

Health Plan Liaison (Posted: 03/28/17)

MedPOINT, a large MSO in the San Fernando Valley offers competitive salaries and benefits in a collaborative working environment. For immediate consideration of this position, please e-mail your resume and salary requirements to personnel@medpointmanagement.com.

Summary:

Effective coordination between IPA Management Company and Providers to ensure timely, accessible care/ services to members.

Duties and Responsibilities:

  • Collects referrals for IPA, date stamps, verify eligibility, check member’s address. Makes appropriate updates as needed.
  • Answers U. M. phone and answers voice mails.
  • Researches benefits as needed.
  • Reviews referrals, calls offices for additional information according to   guidelines.
  • Verify member’s Aid Codes and investigate members’ diagnoses in compliance with medical care.
  • Special Projects
  • Assist medical offices in coordinating care/ referral submission.
  • Alerts licensed staff when case management conditions exist per policy.
  • Screen cases for possible CCS and alert licensed staff.
  • Prints U. M. letters as needed.
  • Attends U. M. meeting as requested.
  • Assists in provider orientations, as requested.
  • Communicate with Medical Directors to facilitate Medical Reviews.

Minimum Job Requirements:

High school graduate. AA preferred. One year medical billing experience.

Eligibility Clerk (Posted: 03/28/17)

MedPOINT, a large MSO in the San Fernando Valley offers competitive salaries and benefits in a collaborative working environment. For immediate consideration of this position, please e-mail your resume and salary requirements to personnel@medpointmanagement.com.

Duties and Responsibilities:

  • Determines eligibility for authorizations for members that are not in the system; information request forms are received from UM and marked either routine or urgent. Also, handles calls from provider offices and/or facilities regarding eligibility.
  • Determines eligibility for claims for members that are not in the system; information request forms are received from the claims department.
  • Enters newly assigned members into EZ-Cap system once verified through one of the above processes.
  •  Reconciles monthly roster with EZ-Cap including member adds or terms (information received on paper file monthly).
  •  Perform other duties as assigned.

Knowledge, Skills, and Abilities

  • Must have EZ-CAP® knowledge.
Compliance Coordinator (Posted: 03/28/17)

MedPOINT, a large MSO in the San Fernando Valley offers competitive salaries and benefits in a collaborative working environment. For immediate consideration of this position, please e-mail your resume and salary requirements to personnel@medpointmanagement.com.

Summary:

MedPOINT Management is committed to conducting its business and operations in accordance with the highest legal and ethical standards. Our Code of Conduct sets forth our expectations of management, employees, and contractors to act in accordance with applicable laws and Company policy. MedPOINT’s Compliance Department works to ensure our culture maintains ethical standards and strives to significantly reduce the risk of fraud, abuse, and waste in the health care industry and enhances quality of services and care to patients. MedPOINT’s Compliance Program is guided by the Federal Sentencing Guidelines for Compliance Programs.

Duties and Responsibilities:

  • Coordinate oversight audits
  • Prepare audit selections to external auditors from health plans
  • Initiate and follow up on Medical Record requests for Health Plan Oversight Audits/Ad Hoc Requests
  • Internal quality reviews of department processes
  • Participate in Regular and Ad Hoc Compliance Committee meetings
  • Assist with maintaining department’s policies and procedures
  • Assist with preparation of Corrective Action Plans (CAPs), tracking results, actions taken, steps to prevent future duplicate or similar CAPs
  • Calendar follow ups to audit CAPs
  • Interface with various departments for compliance related activities as needed
  • Assist with report submissions
  • Serve as a back-up to auditors as needed
  • Miscellaneous projects as assigned to support Regulatory & Compliance department

Minimum Job Requirements:

High School diploma or equivalent. Two (2) or more years in examining, processing and auditing medical claims; Medicare/Medi-Cal experience. Experience in an HMO or in a Managed Care setting preferred. Knowledge of DMHC, DHCS, and CMS regulatory requirements.

 Knowledge, Skills, and Abilities

  • Proficiency in Microsoft Applications, Word & Excel.
  • Knowledge of ICD-9/10, CPT coding and EZ CAP a plus.
  • Professional demeanor, excellent communication and interpersonal skills.
  • Strong organization skills and knowledge of managed care environment.
Claims Inquiry Unit – Call Center Representative (Posted: 03/28/17)

MedPOINT, a large MSO in the San Fernando Valley offers competitive salaries and benefits in a collaborative working environment. For immediate consideration of this position, please e-mail your resume and salary requirements to personnel@medpointmanagement.com.

Summary:

To serve as a liaison between IPA and its members. Ensures that all members receive a level of service that exceeds their expectations. Respond to and resolve questions and problems from current members, or their representative, providers, and other appropriate parties.

Duties and Responsibilities:

Be proficient in discussion and execution including, but not limited to, the following:

  • Benefit clarification, eligibility, verification, and claim status.
  • Medical group/PCP provider assignments
  • Explanation of how the plan works and how to utilize the services
  • Assist with information regarding referral or authorization
  • Request change of provider/member information
  • Any complaints/grievances
  • Update new member eligibility on appropriate systems
  • Perform overrides for covered/authorized prescriptions as needed
  • Participate as a team player by demonstrating support to peers, management, and the department’s goals
  • Attend meetings and training sessions as scheduled
  • Assist with training new employees as needed
  • Show flexibility in meeting performance objectives consistent with IPA and department objectives
  • Document all member inquiries and complaints in appropriate systems and either handle, redirect, or defer to the appropriate department for resolution.

Minimum Job Requirements:

High school diploma. Two years of Customer Service/Telemarketing sales or related experience. Knowledge of Medi-Cal, Managed Care plans

 Knowledge, Skills, and Abilities

  • Must be computer literate, typing 30 wpm
  • Excellent telephone techniques
  • Excellent interpersonal and communication skills; strong writing skills
  • Medical Front Office experience preferred
  • Bilingual in Spanish preferred
AR Specialist (Posted: 03/28/17)

MedPOINT, a large MSO in the San Fernando Valley offers competitive salaries and benefits in a collaborative working environment. For immediate consideration of this position, please e-mail your resume and salary requirements to personnel@medpointmanagement.com.

Summary:

A well-known MSO in the San Fernando Valley is searching for an AR/Recovery Specialist. The successful candidate will be a self-motivated, organized, enthusiastic individual who lives and breathes confidentiality while maintaining and coordinating between AR and the Recovery Team.   The ideal candidate will have a dynamic and creative approach to all aspects of the AR function. The candidate will also work in coordination with AP & Financial Analysts in managing daily processing requirements. Top contenders will perform at a high level processing cash receipts for multiple IPAs. Prepare daily, weekly and monthly AR reports and process special request for specific reports. Coordinate with Recovery to contact clients on accounts receivable issues and collections. Coordinate with AP to generate management fees and maintain AR reports to ensure that the information is correct for AP to run reports for 1099 at the beginning of each year and to coordinate with the analyst to ensure daily cash flow reconciles with daily cash receipts.

Duties and Responsibilities:

  • Demonstrates strong understanding and experience using Excel required.
  • Detail oriented and demonstrated ability to establish priorities and meet deadlines when faced with multiple/competing tasks. Excellent interpersonal skills required to develop and maintain effective working relationships across all levels within the organization.
  • Willingness to ensure the job Is performed within specified parameters and deadlines is essential
  • Exceptional customer service, strong communication, and the ability to be analytical and multi-task are extremely important.
  • Knowledge of Mas200 a plus
  • Detail -oriented, excellent proof reading and editing skills. Excellent technical/computer skills including Microsoft Office Suite and other accounting software programs.
  • Ability to exercise initiative, judgment, and take ownership when dealing with tasks.
  • Maintains information in a confidential manner and complies with HIPAA laws according to policy.
  • Regular and reliable attendance is an essential function of the position.

Minimum Job Requirements:
AA degree or an equivalent combination of education, training and experience is required.

Experience:
1+ years of accounts receivable and collections experience required.

 Knowledge, Skills, and Abilities

  • Strong organizational, analytical and oral/ written communication (English) skills required.
  • Intermediate to Advance level in MS-Excel 2013 or higher.
  • Proficiency in MS Office and PC skills required.
  • Ability to perform multiple tasks while maintaining productivity and quality standards.
  • Ability to work well with others in a professional, team-oriented environment.
  • Must be able to perform independently according to departmental standards with little supervision.

* Please provide resume and salary history.

Crystal Report Writer (Posted: 02/27/2017)

MedPOINT, a large MSO in the San Fernando Valley has an opening for the following position. Competitive salary and benefits in a collaborative working environment. For immediate consideration, please e-mail your resume and salary requirements to personnel@medpointmanagement.com

 Duties and Responsibilities:

  • Crystal Reports Developer/Writer with experience in data analysis and report writing
  • Develop, Repair and update existing and new reports from databases to extract and collect data using complicated MS-SQL code with complex joins
  • Create MS-SQL tables, views, functions, and advanced stored procedures
  • Provide support to functional teams or management by collecting and analyzing data and reporting results
  • Develop ad hoc reports as needed
  • Work closely with staff users and management to establish requirements for reports or modifications and to ensure proper testing and validation of completed reports
  • Performs additional duties as assigned.

Minimum Job Requirements:

  • 5+ years’ experience with crystal reports, data analysis, and report writing
  • Ability to write complicated MS SQL queries with complex joins
  • Strong experience with developing MS-SQL objects (tables, stored procedures, views, etc.)

 Knowledge, Skills, and Abilities

  • Task oriented.
  • Ability to work in a fast-paced team-oriented environment.
  • Ability to work both independently and as part of a collaborative team.
  • Ability to multi-task effectively.
  • Strong problem solving and analytical ability, ability to troubleshoot.
  • Excellent written and verbal communication and organizational skills.
  • Experience with Reportal and/or LaunchPoint (IDM) highly preferred
  • Experience with EZCAP 6x, or other Healthcare management system, highly preferred.
Sr. Application Developer (Posted: 02/27/2017)

MedPOINT, a large MSO in the San Fernando Valley has an opening for the following position. Competitive salary and benefits in a collaborative working environment. For immediate consideration, please e-mail your resume and salary requirements to personnel@medpointmanagement.com

Duties and Responsibilities:

  • Design, develop, test, deploy, and support Windows Desktop and Web applications of high quality, using current software development best practices, with an emphasis on security, performance, scalability, quality, and documentation.
  • Develop business logic and services in C#/ASP.NET/MVC using design patterns.
  • Design, build, create, test MS-SQL objects including tables, stored procedures, views, functions, etc.
  • Work with program management, technical writers, business analysts, and the IT teams.
  • Collaborate on internal projects relative to new company-wide application initiatives or requirements.
  • Performs additional duties as assigned.

Minimum Job Requirements:

  • Bachelor’s degree in a related field (computer science, information systems, etc.) or equivalent experience.
  • 5+ years of formal .NET Windows Desktop and/or Web application development in C#, ASP.NET,MVC
  • Solid understanding of object-oriented programming (OOP) and software engineering foundations
  • Strong experience with HTML5, CSS3, Bootstrap, Less/Sass, AngularJS, TypeScript, JavaScript
  • Strong experience with developing MS-SQL objects (tables, stored procedures, views, etc.)
  • Strong understanding of browser compatibility, cross-browser, and web standards.

Knowledge, Skills, and Abilities

  • Task oriented.
  • Ability to work in a fast-paced team-oriented environment.
  • Ability to work both independently and as part of a collaborative team.
  • Ability to multi-task effectively.
  • Strong problem solving and analytical ability, ability to troubleshoot.
  • Excellent written and verbal communication and organizational skills.
  • Experience with Agile & Scrum development methodology.
  • Healthcare background highly preferred.
UM Outpatient – Utilization Nurse (Posted: 1/9/17)

MedPOINT, a large MSO in the San Fernando Valley offers competitive salaries and benefits in a collaborative working environment. For immediate consideration of this position, please e-mail your resume and salary requirements to personnel@medpointmanagement.com.

Summary:

Responsible for assuring the receipt of high quality, cost efficient medical outcomes for those members identified as having the need for outpatient precertification/preauthorization. Responsible for screening members.

Duties and Responsibilities:

  • Review precertification requests for medical necessity, referring to the Medical Director those that require additional expertise.
  • As part of the UMRN triage program, conduct ongoing availability, monitoring and oversight of non-clinical staff activities.
  • Establish effective rapport with other employees, professional support service staff, customers, clients, patients, families, and physicians.
  • Use effective relationship management, coordination of services, resource management, education, patient advocacy, and related interventions to:
    • Promote improved quality of care and/or life
    • Promote cost effective medical outcomes
    • Prevent hospitalization when possible and appropriate
    • Prevent complications in members under our care when possible
    • Promote Decreased lengths of hospital stays when appropriate
    • Provide for continuity of care
    • Assure appropriate levels of care are received by members
  • Provide appropriate consultation and referral to Case Management personnel.
  • Provide advice and counsel to precertification staff.
  • Identify appropriate alternative and non-traditional resources and demonstrate creativity in managing each case to fully utilize all available resources.
  • Ability to review cases using applicable criteria per line of business.
  • Maintain accurate records of all communications and interventions.

Minimum Job Requirements:

Two years of prior experience with utilization management preferable. Current CA RN/LVN License.

Knowledge, Skills and Abilities Required:

  • Excellent relationship management skills, including a high degree of psychological sophistication and non-aggressive assertiveness.
  • Demonstrate ability to problem solve complex, multifaceted, emotionally charged situations,
  • Ability to engage easily in abstract thought.
  • Medi-Cal managed care experience (CCS, VSP, VFC etc.)
  • Experience in interpreting DOFR’s
  • Ability to successfully manage conflict, negotiating “win-win” solutions.
  • Strong organizational, task prioritization, and delegation skills.
  • Ability to construct grammatically correct reports using standard medical terminology.
  • Patient advocacy focus.
  • Empathy.
  • Proficiency with Microsoft Office Programs; primarily Word and Excel 2013 or higher
  • EZ-CAP® knowledge a plus.

Working Conditions and Physical Effort:

  • Regular and reliable attendance is an essential function of the position.
  • Work is normally performed in a typical interior/office work environment.
  • No or very limited physical effort required. No or very limited exposure to physical risk.
Clinical Decision Lead (Post Date: 11/07/16)

MedPOINT, a large MSO in the San Fernando Valley has four immediate openings for the following position. Competitive salary and benefits in a collaborative working environment. For immediate consideration, please e-mail your resume and salary requirements to personnel@medpointmanagement.com.

Duties and Responsibilities:

Conducts studies and analyzes data to evaluate the IPA’s performance in quality improvement, with duties including but not limited to:

  • Performing computer based statistical analysis of data related to the Quality Improvement Program
  • Completion of ICE Quarterly Reports for all IPAs
  • Monitoring and ensuring the validity of data
  • Performing analysis to determine statistically significant trends in the data compared to industry standards and recognized benchmarks
  • Providing technical expertise in statistical analysis to QM staff and external clients as necessary
  • Creating process documentation for QI/HEDIS activities
  • Collaborating with practices to integrate their EHR data into IPA reporting

Analyzes, develops and implements improvement activities to increase compliance rates as measured by nationally standardized benchmarks and definitions, with duties including but not limited to:

  • Identifying preventive care areas with declining or plateauing compliance rates over time, including root cause analysis for contributing factors;
  • Working with provider offices directly to increase compliance rates and practice improvement
  • Evaluating and reporting compliance rates on a quarterly basis

Assists the QM Supervisor and Manger with HEDIS reporting, with duties including but not limited to:

  • Working with supplemental data sources such as immunization registries and lab/radiology vendors
  • Training staff in the use of Episource and other HEDIS software
  • Serve as a primary contact for HEDIS staff regarding member outreach calls and other ongoing projects

Participates in special projects, as directed
Performs other duties as assigned

Minimum Job Requirements:

  • Bachelor’s Degree in Statistics, Computer Science or Health Care related field; and
  • Three (3) years of experience in statistical analysis pertaining to quality improvement in a managed care environment; or an equivalent combination of education and experience which would provide the required knowledge and skills to qualify for this position

Knowledge, Skills and Abilities Required:

  • Working knowledge of HEDIS reporting
  • Working knowledge of Medicare and STAR ratings
  • Working knowledge and understanding of SQL
  • Working knowledge of Medi-Cal managed care principles
  • Ability to apply the principles and methods of research methodology; statistical analysis and report design
  • Proficient in Microsoft Office products including Excel, Access and Power Point
  • Ability to plan, organize and lead data collection activities
  • Ability to prioritize tasks and deadlines
  • Ability to think and work effectively under pressure and accurately complete tasks within established times
  • Ability to communicate effectively, both orally and in writing
Manager, Quality Management (Post Date: 10/24/16)

MedPOINT, a large MSO in the San Fernando Valley has two immediate openings for the following position. Competitive salary and benefits in a collaborative working environment. For immediate consideration, please e-mail your resume and salary requirements to personnel@medpointmanagement.com.

Summary:

Responsible for day-to-day operations for the credentialing, grievances, member services and Quality Management teams. The QM Manager is responsible for working directly with the supervisors and leads in each area to ensure efficient workflows and task/project completion. Will need to attend several internal and some external meetings with provider/clinic and health plan clients. Active role in development of program to improve HEDIS®, P4P, and STAR scores.

Duties and Responsibilities:

  • Develops and mentors a high-performing team for all areas of responsibility through practice of excellent employee relations, attention to employee needs (including fostering effective working relationships, training, developing/coaching and evaluating), performance improvement initiatives, a collaborative environment.
  • Works with grievance department to ensure that grievances and appeals are completed on time and that completed letters are acceptable
  • Attends credentialing meetings via webinar; assists credentialing staff as necessary to meet program requirements
  • Responsible for the overall direction, coordination and implementation of the QI Program for the MedPOINT managed groups. This will include the collection, management and analysis of quality data and the preparation of quality reports
  • Responds to inquiries from health plans and provider offices/clinics; interfaces with internal and external customers on day-to-day QI issues as they arise.
  • Participates and assist with preparation for all clinical audits and surveys; handles pre-audit and preparation functions for health plan audits
  • Optimizes efficiency with document generation and reporting
  • Continually analyzes quality gap reports for HEDIS® opportunities; presents innovative ideas for improving member and physician engagement

Minimum Job Requirements:

  • Current California Registered Nurse (RN) License
  • Five (5) years combined nursing and/or ambulatory health experience in the hospital and/or ambulatory health setting. Eight (8) years health experience in the hospital or ambulatory health experience in lieu of an RN license

Knowledge, Skills and Abilities Required:

  • Effective verbal and written communication skills and effective interpersonal skills.
  • Ability to write clear concise narratives and statistical reports.
  • Increasingly responsible leadership experience at a management level in the health care field
  • Ability to analyze clinical data, prepare written reports and plans, make informed decisions, take appropriate action and follow through within scope of responsibility
  • Strong knowledge and understanding of HEDIS®, Commercial P4P and STARs Programs
  • Ability to work well with others in a professional, team-oriented environment
  • Ability to analyze, interpret and prepare reports.
  • Familiarity with Electronic Health Records
  • Proficiency with Microsoft Office Programs; primarily Word and Excel 2013 or higher
  • EZ-CAP® knowledge a plus.