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MEDPOINT MANAGEMENT
Woodland, CA | Full Time
$60k-79k (estimate)
2 Weeks Ago
Specialist, Clinical Operations
$60k-79k (estimate)
Full Time 2 Weeks Ago
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MEDPOINT MANAGEMENT is Hiring a Specialist, Clinical Operations Near Woodland, CA

Summary

Under the direction of the Supervisor, Clinical Operations (COPS), the Specialist, COPS primary responsibility is to support a strategic approach to the development of actionable recommendations that improve the quality, access, and sustainability of MedPOINT’s clients’ network.

Duties and Responsibilities:

  • Member of MPM’s COPS committee, with the goal of identifying claims & UM initiatives to drive cost efficiency and quality improvement for MPM Clients
  • Identify key utilization areas for analytical focus, especially those with potential opportunity and risk
  • Utilize analytical tools to examine provider behavior & practices to optimize operational efficiency
  • Support the development and communication of strategic recommendations based on analyses to MPM Executives during COPS committees
  • Lead efforts, both internally and externally, to operationalize strategic recommendations pertaining to MPM activities and also inform and drive change with external vendors, providers, and stakeholders
  • Advance COPS initiatives with other departments, including Utilization Management, Claims, Compliance, and Finance
  • Develop and lead efforts around workflows between UM and Claims departments
  • Research and build the knowledge base for COPS and SOPI initiatives by attending conferences and pursuing self-study in areas regarding billing practices, provider behavior and operational improvements that could benefit COPS Committee and MPM operations
  • Mitigate financial impact and utilization via ad hoc clinical review with other departments and lead & advise other departments in their continuous improvement efforts when pertaining to clinical review
  • Build and maintain relationships with UM and Claims Leadership to be a key advisor to their departments on behalf of SOPI
  • Provide clinical review and identify potential fraud, waste, and abuse practices

Minimum Job Requirements:

  • Clinical background with intimate knowledge of injectables, coding practices, and normal billing procedures
  • Familiarity with current managed care regulatory processes
  • Intermediate proficiency with Microsoft Office Excel
  • Familiarity with EncoderPro and Virtual Examiner

Skills and Abilities:

  • Capable of completing complex longitudinal analyses
  • Positive attitude and flexibility, a must
  • Ability to deliver on departmental and company goals
  • Ability to work effectively with all levels of the organization and stakeholders
  • Ability to learn about regulatory requirements and provider contracting

Salary Range:

  • $75k-85k annually

Job Summary

JOB TYPE

Full Time

SALARY

$60k-79k (estimate)

POST DATE

05/06/2024

EXPIRATION DATE

05/11/2024

WEBSITE

medpointmanagement.com

HEADQUARTERS

WOODLAND HILLS, CA

SIZE

25 - 50

FOUNDED

1988

CEO

SHELDON LEWENFUFF PREIDENT

REVENUE

$10M - $50M

Related Companies
About MEDPOINT MANAGEMENT

MedPoint Management provides IPA management, development and consulting services as well as comprehensive claims processing, medical affairs and financial operations. Clients receive the services of a large medical system in a smaller, more personal setting. MedPOINT Management, Inc. (MPM) provides all aspects of managed care management services to Independent Practice Associations (IPAs) and hospital clients. Our customized management approach meets the unique needs of each of our clients which allows us to successfully manage smaller groups comprised of single physician practices along with ...large groups of FQHC clinics and all practice models in between. Our experienced and knowledgeable staff provides a consistently high level of healthcare management services and strategies. Innovation and commitment to high quality, cost-effective care contribute to the overall satisfaction of our clients and members. Founded in 1987, MedPOINT currently represents a client base of over 4,000 contracted providers throughout California. Our managed IPAs are responsible for coordinating care for over 950,000 members in multiple contracted health plans. The contracts represent various payer mixes including Commercial HMO/PPO, Medi-Cal, Covered California (Exchange), Medicare Advantage and Medi-Medi including CalMedi Connect product lines. Understanding the power of information, MPM has made a significant investment in sophisticated IT systems enabling our management, clinical and administrative staff to efficiently work to coordinate high quality, cost effective, integrated care. The ability to readily track and trend utilization and quality metrics has been a vital component in improving overall health management, impacting the delivery of chronic and episodic care, yielding favorable health outcomes, and assisting our provider networks to meet or exceed health plan benchmarks for HEDIS, STARs and P4P programs. MedPOINTs full range of services are consistently delivered with the same high quality standards that has built our reputation. Flexibility, innovation and an openness to change are what the future demands of us as the nation moves into a new era of Health Care reform. The services MPM is delivering today will continue to embrace these notions to add value to our current and future client base. More
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