MedPOINT Careers

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

Hospital Risk Pool Reporting Analyst (Post Date: 7/20/17)

MedPOINT, a large MSO in the San Fernando Valley has an 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:

The Hospital Risk Pool Reporting Analyst leads the preparation and presentation of financial, clinical and business analysis. This includes the accurate quantification and measurement of clinical outcomes. In addition, other key responsibilities include the oversight and development of operating plans and financial solutions that promote an environment of effective decision-making, revenue enhancement, cost efficiency, and sound business practices. Works closely with other hospital teams to develop and package financial products and services catered to meet the specific needs of MPM customers. Ensures the effective and timely delivery of quality financial/information products and services to MPM clients. The financial analyst is a key liaison and “front-line” financial resource between hospital operations and Strategic Finance and serves to create a forward-focused guiding vision and environment of “no surprises”

Duties and Responsibilities:

  • Develops systems to assure the timeliness if risk pool reconciliations.
  • Develops financial models for new ventures.
  • Performs historical studies to forecast future costs.
  • Develops subcapitation and risk pool models.
  • Develops models to evaluate provider contract proposals.
  • Identifies trends in claims expenses and recommends methods for reduction.
  • Coordinates requests for analysis from internal and external clients including assignment, mentoring and establishing timelines.
  • Performs research on industry performance measures for evaluation of client performance.
  • Develops and maintains systems that allow for ease of data retrieval and manipulation from a variety of sources including claims payment, utilization management, health plan risk pools, subcontractor capitation, internal charges, subcontractor risk pools and others.
  • Assures accuracy and timeliness of subcapitation payments.
  • Disperse reports to Hospital Client and MSO Financial Analyst
  • Prepare and submit any additional requested reports to Hospital Clients
  • Prepare EOM financial and board packages
  • Prepare ad-hoc financial analysis as requested by the Controller, CFO and/or the client
  • Prepare other financial packages and ad-hoc reports as need for Operations Meeting

Minimum Job Requirements:

  • Bachelor’s degree or an equivalent combination of education, training and experience is required.
  • 3+ years of Physician Organization or Health Plan, Hospital Finance and/or Health Plan experience.
  • Definitive understanding of provider and health plan contracting, delineation of risk, medical terminology and standard industry reimbursement methodologies required.

Knowledge, Skills and Abilities Required:

  • Demonstrates advanced understanding and experience using Excel (VBA’s, macros. Pivot tables, vlookup, hlookup), MS Access and other Microsoft Office Systems required.
  • Must be highly analytical and possess a strong grasp of finance concepts such as capital budgeting, discounted cash flow, financial statement analysis and forecasted.
  • Experience in and knowledge of CPT, HCPC, DRG, ICD-9, ICD-10 and NDC coding is a plus.
  • Ability to communicate clearly and effectively, work accurately, meet deadlines and provide effective reporting is required.
  • Excellent interpersonal skills required to develop and maintain effective working relationships across all levels within the organization.
  • Ability to work both independently and as part of a team.
  • Willingness to ensure the job is performed within specified parameters and deadlines is essential
  • Crystal/SQL knowledge and experience necessary
  • Knowledge of Mas200, Ez-cap a plus
  • Medi-Cal/Medicare/MHC knowledge is a must
  • Demonstrate ability to plan, organize and manage modest projects successfully.
  • Ensures accuracy and readability of for all team projects.
  • Requisite poise, judgment, and trustworthiness to represent MSO to internal and external groups
  • Must work effectively in a team environment and able a supportive contributor or leader in team matters.  Must conduct him or herself professionally and be capable of developing and maintaining positive, service oriented relationships with all levels of healthcare professionals, both internal and external to VHS, as well as Board members, administration and others.
  • Must be able to plan, coordinate and prioritize resources.
  • Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
  • Performs additional duties as assigned.

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.
Recovery Analyst (Post Date: 7/20/17)

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:

As a Recovery Analyst you will be working with internal and external business units to research recovery issues to determine the validity of overpaid medical claims and the validity and accuracy of provider overpayment and health plan cap deducts and to ensure database information is accurate for reporting purposes. You’ll be responsible for reviewing, auditing and maintaining database entries on a daily basis and to utilize research to help implement business process improvement. This role will also include generating reports for team production and work distribution. Throughout your work, you’ll ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance.

Duties and Responsibilities:

  1. Examine, Leads, coordinates and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
  1. Prepare weekly, monthly and quarterly reports showcasing recovery trends and possibilities for process improvements.
  2. Run audit reports to identify possible recoveries.
  3. Draft Visio flowcharts
  4. Assemble spreadsheet, charts and graphs to provide financial support and analysis
  5. Extensive research to determine accuracy of database entries to help implement business controls for current and future processes
  6. Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
  7. Investigate and pursue recoveries and payables on claims and file management
  8. Prepare summaries and reports to track and measure productivity and status
  9. Process recovery on claims
  10. Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
  11. Complex data modeling
  12. Ad-hoc analysis and reporting
  13. Use pertinent data and facts to identify and solve a range of problems within area of expertise
  14. Ability to identify and understand the data needs of a growing organization
  15. Structure and prepare analysis to support and lead decision making
  16. Serves as a resource to others
  17. Other projects as assigned by Supervisor

Minimum Job Requirements:

Bachelor‘s degree in accounting, finance, economics or mathematics.

Knowledge, Skills and Abilities Required:

  • Experience demonstrating intellectual curiosity, logic, analysis and accounting-style problem solving skills
  • Strong analytic and communication skills
  • Ability to work complex projects independently with minimal oversight
  • Success managing and multi-tasking across multiple reports, projects and tasks
  • Experience with web based data entry systems
  • Applicant must be proactive, have excellent organizational skills with attention to detail, exemplary oral/written communication and strong analysis and computer skills.
  • Advanced knowledge of Microsoft Office Suite, including but not limited to Word, Excel, Access, and Visio
  • Strong verbal and written communication skills
  • Strong interpersonal skills and ability to interact with multiple departments and management
  • Ability to prioritize time
  • Work on multiple tasks with ongoing deadlines
  • Ability to adapt and change gears, take on special projects and work on tasks outside of current scope
Outpatient UM – Level One Coordinator (Post Date: 7/20/17)

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:

Answer incoming calls from clients to answer inquiries and questions, handle complaints, troubleshoot problems and provide information.

Duties and Responsibilities:

  1. Answer calls and respond to emails.
  2. Handle customer inquiries both telephonically and by email.
  3. Research required information using available resources.
  4. Provide customers with product and service information.
  5. Identify and escalate priority issues.
  6. Route calls to appropriate resource.
  7. Follow up customer calls where necessary.
  8. Document all call information according to standard operating procedures.

Minimum Job Requirements:

Medical Terminology. High School Diploma. Bilingual preferred. 1 year experience customer service.

Knowledge, Skills and Abilities Required:

  • Verbal and written communication skills
  • Listening skills
  • Problem analysis and problem solving
  • Customer service orientation
  • Good organizational skills
  • Ability to multitask
  • Attention to detail
  • Adaptability
  • Team work
  • Proficient in Microsoft Office 2010 or higher software applications
  • Ability to be flexible in high volume setting
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.
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.
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