57 jobs in North East Medical Services

The MSO System Configuration Analyst is responsible for the major managed care systems configurations, including EZ-CAP, EZ-CARE, EZ-EDI, EZ-Net, health plan implementations and conversions within the System Configuration team.

The primary responsibilities include the accurate interpretation of specific state and/or federal guidelines that impact Medicare and/or Medi-Cal benefits, NEMS risk contracts, codification, and business requirements and converting them into configuration parameters within the core systems. Identify regular fee schedule updates as published by CMS and DHCS and transform into system configuration scheme. Monitor monthly encounter data and report submissions to contracted Plans, DHCS, and CMS; review correspondence and take appropriate follow up actions to accomplish data accuracy and completeness requirements for all managed care programs including PACE, Medicare Advantage and Medi-Cal. Develop reports to monitor system performance and promote integration and automation of systems workflows. Other responsibilities include maintenance of benefit modules, provider profiles set-up (demographic and contracts affiliations), fee schedules, regular coding updates and various system tables through the user interfaces.

The position is also required to produce data reports as demanded by contracted health plans, DHCS, and CMS; reconcile eligibility and capitation data discrepancies between plans and NEMS data; prepare statistic reports to support decision making in managed care business developments. This position will assist in the regular internal review, analysis and audit to all PACE related data issues; identify errors and propose resolutions; collaborate internally with PACE team and communicate externally with entities including DHCS, CMS, PDAC, PharmaStar, etc. to resolve discrepancies and dissimilarities. This position requires significant level of critical thinking skills, current technical knowledge of MSO operations, processes, workflows, and understanding to the managed care operational structure, coding, benefits, and relevant degree of creativity and latitude.

• Interprets state and federal guidelines that impact managed care system configuration and convert configuration parameters within the MSO core systems, including updates and changes in benefit coverages, fee schedule rates, provider geographic rate adjustments, EDI transmission and date specifications, report submissions and timelines, etc.
• Develops, loads, edits, and maintains EZ-CAP, EZ-CARE, EZ-EDI, EZ-Net, and any additional system configuration items; automate system workflows to promote operational efficiency.
• Performs analytical reviews and technical supports for defining, tracking, and resolving issues in the managed care core systems.
• Monitor monthly encounter data and other report submissions to contracted Health Plans, DHCS, and CMS; review correspondence reports and take appropriate follow up actions to accomplish data accuracy and completeness requirements, for all managed care programs including PACE, Medicare Advantage and Medi-Cal.
• Responsible to independently perform regular internal review, analysis and audit to all PACE related data issues; identify errors and propose resolutions; communicate and collaborate internally with PACE team and externally with entities including DHCS, CMS, PDAC, PharmaStar, etc. to resolve discrepancies and dissimilarities.
• Assist in conducting system testing, validation and analyze outputs and results to allow for continuous improvement of the overall QA process for the MSO EZ-Suite system accuracy, integrity, and performance.
• Communicates with other MSO operational teams to understand workflow needs; design, develop and refine Work Queue processes in core managed care systems to strengthen system enhancement activities including data mapping, system integration and workflow automation to meet and improve operation needs.
• Creates and analyzes statistics reports for other operational teams in assist of evaluating business performance links to MSO medical management services.
• Designs training courses and creates training materials to support EZ-Suite users; initiate training and retraining sessions to support department operations and ensuring users are properly updated to maximize system performance.
• Responds to system configuration flaws/errors and unresolved issues, report and propose to MSO Director and EZCAP Product Development team for resolutions.
• Creates data reports per health plans’ delegation agreement; reconciles eligibility and capitation data discrepancies between contracted Health Plans, DHCS, CMS and NEMS data.
• Supports MSO audit activities performed by various entities, including contracted Health Plans, DHCS, and CMS.
• Prepares other additional statistical reports to support decision making in managed care business development and to support operational initiatives and activities.
• Performs other job duties as required by manager/supervisor.

• Completion of a 4-years degree from an accredited University in System Analysis, Computer Programming or other relevant area of study.
• Three (3) years technology and business analysis experience in Managed Health Care industry with working knowledge of how Benefits, Rates, Fee Schedules, and Provider Contracts impact the payment and processing of claims;

• Working knowledge of State/Federal healthcare compliance requirements (HIPAA, AB1455, HL7, X12, and ICE standards), particularly DHCS/Medi-Cal guidelines;
• Working knowledge of healthcare standard code sets, benefits, DOFR, RBRVS, and fee schedules;
• Must have strong analytical and problem-solving skills across a wide variety of configuration and technical issues.
• Demonstrated ability to use Microsoft Access, Excel, Crystal Reports, Report Builder and SQL Server Reporting Services.
• Ability to self-manage in a detail-oriented environment.
• Good organization and prioritization skills, outstanding in time management.
• Ability to reliably and consistently deliver quality work product on target dates.
• Strong written and verbal communication skills to allow for effective communication at any level.

• Must be able to fluently speak, read and write English.
• Fluent in other languages are an asset.

This is an FLSA NON-exempt position.
This is not an OSHA high-risk position.

NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).

The MSO System Configuration Analyst is responsible for the major managed care systems configurations, including EZ-CAP, EZ-CARE, EZ-EDI, EZ-Net, other wrap-around applications and health plan implementations and conversions within the System Configuration team. Responsible to perform validation testing to production database post system upgrades and installation of new modules, implementation of hotfixes, etc. which requires after-hour/weekend operation independently without onsite supervision.

The primary responsibilities include the accurate interpretation of specific state and/or federal guidelines that impact Medicare and/or Medi-Cal benefits, NEMS risk contracts, codification, and business requirements, and converting them into configuration parameters within the core systems. Identify regular fee schedule updates as published by CMS and DHCS and transform into system configuration scheme. Monitor monthly encounter data and report submissions to contracted Plans, DHCS, and CMS; review correspondence and take appropriate follow up actions to accomplish data accuracy and completeness requirements for all managed care programs including PACE, Medicare Advantage and Medi-Cal. Develop reports to monitor system performance and promote integration and automation of systems workflows. Strengthen system enhancement activities including data mapping, system integration and workflow automation. Other responsibilities include maintenance of benefit modules, provider profiles set-ups and regular audits (demographic and contracts rates/affiliations), fee schedules, regular coding updates and various system tables through the user interfaces.

This position is responsible to independently perform regular internal review, analysis and audit to all PACE related data issues; identify errors and propose resolutions; collaborate internally with PACE team and communicate externally with entities including DHCS, CMS, PDAC, PharmaStar, etc. to resolve discrepancies and dissimilarities.

The position requires the ability to produce data reports as demanded by contracted health plans, DHCS, and CMS; reconcile eligibility, capitation, claims and authorization data discrepancies between plans and NEMS; prepare statistical reports to support decision making in managed care business developments.

This position requires significant level of critical thinking skills, independent judgment, current technical knowledge and experience of MSO operations and workflow processes.

• Interpret state and federal guidelines that impact managed care system configuration and convert configuration parameters within the MSO core systems, including updates and changes in benefit coverages, fee schedule rates, provider geographic rate adjustments, EDI transmission and data specifications, report submissions and timelines, etc.
• Develop, transform, edit, and maintain EZ-CAP, EZ-CARE, EZ-EDI, EZ-Net, and any additional system configuration framework and substructure; automate system workflows to promote operational efficiency.
• Perform analytical review and technical supports to diagnosis, define, track, and resolve critical issues in the managed care core systems.
• Monitor monthly encounter data and other report submissions to contracted Health Plans, DHCS, and CMS; review correspondence reports and take appropriate follow up actions to accomplish data accuracy and completeness requirements, for all managed care programs including PACE, Medicare Advantage and Medi-Cal.
• Responsible to independently perform regular internal review, analysis and audit to all PACE related data issues; identify errors and propose resolutions; communicate and collaborate internally with PACE team and externally with entities including DHCS, CMS, PDAC, PharmaStar, etc. to resolve discrepancies and dissimilarities.
• Perform independent system testing and validation, analyze outputs and results to allow for continuous improvement of the overall QA process for the MSO EZ-Suite system accuracy, integrity, and performance
• Collaborate with other MSO and PACE operational teams to understand workflow needs; design, develop and refine Work Queue processes in core systems to strengthen system enhancement activities including data mapping, system integration and workflow automation to meet and improve operation needs.
• Design, create and analyze statistical reports for other managed care operational teams to assist in the evaluation of business performance links to medical management services.
• Design and update training courses and materials; initiate training and retraining sessions to support department operations and ensuring users are properly updated to maximize system performance.
• Respond to system configuration flaws/errors and unresolved issues; analyze its criticality, and propose to MSO Director and EZCAP Product Development team for resolutions.
• Create and submit monthly data reports per health plans’ delegation agreement; reconcile eligibility, capitation, claims and authorization data discrepancies between contracted Health Plans, DHCS, CMS, and NEMS data.
• Responsible to generate and submit regular and ad-hoc reports to support manage care audit activities performed by various entities, including contracted Health Plans, DHCS, and CMS.
• Prepare regular statistical reports to support decision making in managed care business developments; respond to ad-hoc analysis and development requests under the direction of MSO Director as required to support operational initiatives and activities.
• Performs other job duties as required by manager/supervisor.

• Completion of a 4-years degree from an accredited University in System Analysis, Computer Programming or other relevant area of study.
• Five (5) years technology and business analysis experience in Managed Health Care industry with working knowledge of how Benefits, Rates, Fee Schedules, and Provider Contracts impact the payment and processing of claims;
• Minimum two (2) years system configuration experience in EZCAP and/or other system(s) or application(s) that integrate or interface with EZCAP.

• Working knowledge of State/Federal healthcare compliance requirements (HIPAA, AB1455, HL7, X12, and ICE standards), particularly DHCS/Medi-Cal guidelines;
• Working knowledge of healthcare standard code sets, benefits, DOFR, RBRVS, and fee schedules;
• Must have strong analytical and independent problem solving skills across a wide variety of configuration and technical issues. Demonstrate willingness to make decision within Analyst’s scope of practice, exhibit sound and ethical judgment.
• Demonstrated ability to use Microsoft Access, Excel, Crystal Reports, and SQL Server Reporting Services.
• Minimum two (2) years working experience with Microsoft SQL programming and database development.
• Ability to self-manage in a detail-oriented environment. Willing to work after-hour and weekend as needed to perform task independently.
• Good organization and prioritization skills, outstanding in time management.
• Ability to reliably and consistently deliver quality work product on target dates.
• Strong written and verbal communication skills to allow for effective communication at any level.

• Must be able to fluently speak, read and write English.
• Fluent in other languages are an asset.

This is an FLSA exempt position.

This is not an OSHA high-risk position.

I acknowledge that I have read, understood and accept this job description and am able to perform these essential job functions without restrictions. I also understand that it may be modified from time to time.

NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).

Working under the supervision of the PACE Center Manager, the PACE PT is independent in the application of physical therapy knowledge and skills. Provides autonomous professional physical therapy services as member of the NEMS PACE interdisciplinary team. Plans, organizes, and conducts a comprehensive program of individual and group physical therapy services to enable participant to achieve optimal levels of independent functioning and improve or restore functions which have been impaired, reduced or permanently lost by illness or injury. Provides consultation and teaching to participants, families, and the PACE interdisciplinary team (IDT). Demonstrates the knowledge and skills necessary to assess, plan, care for and provide service to frail elderly participants according to the assigned responsibilities and NEMS PACE standards. Participates in the supervision of rehab therapy assistant(s).

• Conducts initial and periodic physical therapy assessments to determine PACE Participants’ care needs, preferences, and goals. Establishes realistic and measurable goals and sets up treatment plans to administer rehabilitation treatment.
• Remains alert to pertinent input from other team members, Participants, and caregivers and updates the IDT promptly regarding any changes in Participants’ condition or medical status.
• Evaluates participants by applying diagnostic and prognostic procedures; evaluates participant’srehabilitationpotential.
• Participates in the development and revision of the participant’s plan of care as an active member of the interdisciplinaryteam.
• Develops and implements a rehabilitation program to promote, restore or maintain participant’s optimumleveloffunctioning, ensuringintegrationintointerdisciplinaryplanofcare.
• Conducts an ongoing evaluation of the participant’s rehabilitation program to assess the progress and effectiveness of treatment.
• Reports participant’s treatment response to the NEMS PACE interdisciplinary team; changes treatment plan and goals,accordingly.
• Providesdirectphysicaltherapyforparticipants.
• Instructsparticipantandtheir decision-makersregardingin-homeexerciseprogram, gaittraining, transfers, ADL care, homemodification, and on thecareanduseofequipment.
• Consults with participant and their decision-makers regarding individual expectations, as well as, long-and short-termgoals.
• Makes recommendations for equipment, transportation and community services referrals for participants,aswellas,rehabilitativesupportforfamily.
• Provides training to professional and paraprofessional staff in body mechanics, use of equipment, bed mobility, transfers, gait patterns, home exercise program, etc.
• Supervises paraprofessional staff in theperformanceof their duties as they relate to Physical Therapy. Documents the supervision, perestablishedprocedures.
• Maintains productivity per programexpectation.
• Maintainsnecessaryrecordkeepingfunctionspertainingtoparticipantcareandprogress.
• Provides home visits & home health as needed.
• Utilizes Epic appropriately and efficiently and serve as content and workflow expert for resolving issues and proposing solutions in Epic.

• Knows and adheres to the philosophy and goals of NEMS PACE.
• Supportsaquietandsafeenvironmentforparticipants,visitors,andstaff.
• Maintainsconfidentialityofparticipantrecords,reports,anddiscussions.
• ParticipatesinformulationandmaintenanceofNEMSPACEpoliciesandprocedures, especially as they relate to rehabilitation program and services.
• Participates in NEMS PACE Committee(s), as directed by the Center Manager.
• Advises theCenter Managerin ways and means to establish better accountability ofNEMSPACEservices to participants and referralsources.
• Attendsandparticipatesinscheduledstaffmeetingsandparticipantcaremeetings,asrequested.
• Maintains flexibility in schedule and responds to unexpected emergencies and changes in workload in order to fulfillresponsibilities.
• Utilizes supplies and equipmenteconomically.
• Promptly informsthe Center Managerof“unusualincidents.”
• Is professional in appearance and manner in the clinical area; recognizes own limits and seeks help and guidance when indicated; responds in a positive manner to constructive criticism; serves as a role model for students and staff.
• Optionally holds membership in related professional organizations.
• Complies with federal and state regulations.
• Complies with APTA code of ethics.
• Complies with continuing education requirements.
• Performs other job duties as required by manager/supervisor.
• May provide after-hours on-call coverage to support PACE participants when the PACE Center is closed as needed for support.
  

• Bachelor, Master or Doctoral degree approved by the California Board of Physical Therapy.
• Licensed to practice as a physical therapist in California.
• Must meet the educational requirements set by the California Board of Physical Therapy.
• Current BLS and First Aid required.

• At least one year of clinical experience working with the older adult population.
• Twoto five years professional experience in Physical Therapy in a health care setting (not includinginternship).

• Must be able to fluently speak, read and write English.
• Fluent in Chinese (Cantonese) preferred.
• Fluency in other languages in an asset.

This is an FLSA exempt position.
This is an OSHA high-risk position.

Sign On Bonus: 2 Year Commitment

NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).

The Health Education Program Coordinator manages and implements health education programs, develops community education and outreach activities, and counsels patients.

• Develops, implements, coordinates, and evaluates bilingual health education programs and activities on preventative health care, chronic disease management, Western medicine, and other related topics
• Develops curricula, toolkits, health education programs and materials
• Provides group class and/or one‑on‑one health education services to members and the general public
• Acts as primary liaison with appropriate community agencies and schools to establish, promote, and carry out community education and outreach programs
• Manages Health Education centers
• Counsels patients on a variety of subjects such as diabetes, hypertension, asthma, smoking cessation, substance abuse, teen health, Hepatitis B, preventive cancer screening and immunization, etc.
• Coordinates with clinical departments to develop bilingual educational material
• Reviews translations of materials for accuracy and appropriateness
• Researches grants and funding opportunities, and assists in writing grant proposals
• Collects, tabulates, analyzes program data, and prepares reports
• Works collaboratively with Administration and Project Management Department, and provides support in health information projects such as activity schedule, newsletter, informational displays, flyers posters, staff bulletin, community health events, etc.
• Travels to NEMS’ clinic site to conduct programs and events
• Supervises summer interns and volunteers and assists in implementing education activities for the Health Center Week
• Performs other job duties as required by manager/supervisor

• Bachelor’s degree (degree in public health or related field preferred).
• CHES certification preferred
• Two years’ experience in community health education, health communication or related field preferred
• Prior experience in program planning, design and implementation that incorporates evidence‑based strategies and cultural competency
• Experience with formative research or program evaluation preferred
• Prior experience working with the underserved, immigrant, low‑income and/or Asian communities preferred
• Current documentation of Basic Life Support is required

• Must be fluent in English (reading, writing, and speaking)
• Must be fluent in Chinese: Cantonese and or Mandarin (reading, writing, and speaking)

This is an FLSA Non‑exempt position.

This is not an OSHA high‑risk position.

NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).