Career Listings

JOB OBJECTIVE  

The Business Intelligence Developer (Developer) will provide expertise in SQL Server BI Development and work with various data repositories. The developer will be working to develop full stack BI solutions which include implementing of data warehouse, ETL process, data analytics, predictive analysis/trends/patterns, data quality, data governance, interactive visualization, and dynamic reporting.  The Developer is responsible for leading the development of reporting and analytics solutions for Clinicas’ electronic health record (EHR) system by gathering business needs, documenting requirements, identifying appropriate data sources, and developing reports and dashboards. Developers interact with a multi-cultural population of diverse socioeconomic backgrounds, levels of education and ages.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

The Business Intelligence Developer is responsible to perform all, but not limited to, the following duties:

• Develops reports, self-service/interactive dashboards, and analytics packages using business intelligence suite of tools such as Tableau, SSAS, SSRS, SSIS, SSDT
• Calculates clinical metrics using healthcare data from various sources
• Extracts, integrates, and processes data to support reporting of provider’s clinical performance, risks, outcomes, and population’s health
• Designs and automates data preparation and reporting programs
• Validates the integrity and accuracy of data
• Participates in project planning, report formats, and statistical methodologies
• Investigates and evaluates alternative solutions to meet business needs
• Develops data models, architects and builds scalable/high availability data warehouse environments
• Supports the EMR, EPM, claim, and finance data warehouse
• Acts as an informed and thought partner with business users to analyze data to find answers to complex problems
• Acts as a liaison with end-users to collaborate on short and long term reporting requirements
• Determines project requirements for reporting activities and prepares project plans
• Translates requirements into repository and design; documents all design specifications
• Assists in defining best practices and implementation standards for the data warehouse and across business intelligence and reporting delivery tools
• Independently and/or collaboratively develops solutions that are high performance
• Provides technical and administrative support of complex, enterprise-wide analytics systems to ensure data integrity and proper system functioning
• Adheres to and promotes best practices and standards work for all recurring activities

• Mentors less experienced team members and business users on analytics principles and best practices
• Stays current on relevant industry developments—payment reform, regulations, quality measurement programs such as UDS, HEDIS, and Meaningful Use, performance improvement
• Performs other duties as assigned including participation in all safety programs which may include assignment to an emergency response tea

JOB OBJECTIVE

The Chief Medical Officer (CMO) directs all patient care and quality assurance operations related to medical services for Clinicas del Camino Real, Inc. (Clinicas). Provides medical oversight, expertise and leadership to ensure the delivery of affordable quality healthcare to the underserved community. The CMO is a key member of the Executive Management team, engaged in defining the overall business strategy and direction of the organization. Works with an established support system under the direct supervision of the Chief Executive Officer. Interacts with a multi-cultural population of diverse socioeconomic backgrounds, levels of education and ages.  

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

The CMO performs the following duties and responsibilities:

• Leads and implements the clinical direction of the organization
• Keep abreast of emerging models in health care delivery; identifies and defines new and innovative strategies to achieve business goals and objectives.
• Provides and enforces high quality care with a goal of optimizing the health status of the community
• Formulates medical program policies and procedures; directs and evaluates program development.
• Reviews credentials for and delineates privileges for physicians
• Collaborates in the recruitment and retention of qualified, motivated Clinical staff
• Coordinates professional educational and training programs
• Identifies opportunities for collaboration with medical community and specific institutions
• Continually searches for ways to increase the efficiency of health care services provided by Clinicas
• Monitors and evaluates performance of medical physicians
• Oversees Quality Improvement and Quality Assurance.  Chairs monthly Quality Assurance meetings and the quarterly Performance/Quality Improvement committee.
• Provides clinical perspective, analysis, and guidance in relation risk management and any medical liability, malpractice claims.
• Advocates for Clinicas Del Camino Real, Inc. and act as a liaison between administration and the medical staff.
• Strategizes, develops and implements innovative clinical programs that include collaboration with strategic business partners.
• Responsible for selecting, contracting and maintaining relationships with physician advisors who provide the medical expertise in medical and surgical specialties to determine medical necessity and appropriateness.
• Provides physician oversight of medical care management and utilization review.  Provides clinical guidance in complex medical decision processes.
• Performs other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.

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Clinicas is committed to improving and protecting the health of our community and those we serve. As a health care organization, we aim to lead by example and therefore, COVID vaccination is a requirement for all Clinicas employees (exceptions exist only for those who cannot obtain the vaccine due to religious beliefs or qualifying medical reasons). Proof of full vaccination will be requested.

About The Company:

As a Federally Qualified Health Center, we are looking for candidates whom are passionate in serving our underserved population in Ventura County. Moreover, Clinicas’ predominately bilingual and bicultural support staff prides itself in delivering its services on a personal and humane basis, and especially reaches out to members of the community who are traditionally underserved due to limited income, resources, cultural and linguistic barriers. We are looking to have healthcare providers who care about the disparities underrepresented communities face. 

Under the supervision of the CBDO, responsible for assuring the receipt of high quality, cost efficient medical outcomes for patients.   

ESSENTIAL FUNCTIONS AND RESPONSIBLITIES

1.   Develops and administers policies and procedures for utilization control of outpatient and outside referral services. Assists in the development and implementation of procedures to track and trend specialty and ancillary service utilization within the health centers.

2. Responsible for monitoring referral patterns and making recommendations to the Chief Medical Officer on strategies to contain costs, improve access and ensure quality care; and ensures implementation of practice guidelines and referral criteria established by the Chief Medical Officer.

3. Responsible for the maintenance of good community relationships with providers who provide services to MedPartners patients and ensures a responsive system for authorization of services and payment of claims; and assisting in negotiating access to care in targeted areas, as requested.

4. Prepares statistical and narrative reports as requested by management on utilization patterns, expenditures by area and revenue stream, demographics of service delivery and trending of expenditures by program.

5. Establishes and amends, as necessary, a reporting system for contract providers; monitors and analyzes the use of services from outside providers.

6. Trains professional clinic staff on current standards of Utilization Management, medical/surgical diagnosis and treatment coding and reimbursement methodologies.

7.  Reviews incident reports and responds to grievances filed on behalf of members related to quality concerns.

8.  Serves on Safety, Performance and Quality Improvement (P/QI), and Compliance Committees.  Presents data, trends, and grievances as applicable to identify how to measures to improve processes and mitigate risk moving forward.

9.  Conducts or oversees Facility Site Reviews of contracted providers per regulatory requirements to ensure compliance with quality, safety, and accessibility standards.

10.  Responsible for day to day supervision, staff training, monitoring documentation and available resources.

11. Performs other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.

Under the supervision of the Health Center Manager, the Healthcare Greeter (Greeter) will welcome and screen patients, employees and visitors at entrances to their assigned health center.   They will provide direction and general information to individuals entering the building.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

The Greeter will be responsible for performing some or all of the following duties:

• Stationed outside of the health center, the Greeter will provide a positive first impression to patients, employees, and visitors by displaying excellent customer service
• Interact in a professional manner and work collaboratively with Clinicas’ staff and patients
• Follow approved script asking individuals entering the facility questions to protect against COVID-19 exposure. The screening process will also include checking temperatures
• Must be able to wear Personal Protective Equipment (PPE) at times when required.
• Performs other duties as assigned including participation in all safety programs, which may include assignment to an emergency response team

Provide nursing care to clinic patients; prepare patients physically and psychologically for treatment examinations, and scheduling diagnostic studies; teach patients to care for their particular needs; responsible for recognizing and interpreting symptoms and reporting condition of patients to the attending physician; responsible for keeping inventory of stock medicines available and making drug and medical supply orders bimonthly or as needed; administer treatments and medication under physician’ orders; responsible for preparing in-house monthly reports as well as immunization report; other duties might be assigned. Provide supervision of appropriate personnel, coordinate patient flow activities and assist with peer review of patient records in their quality of care system.

• Provide nursing care to clinic patients • Prepare patients physically and psychologically for treatment examinations, and scheduling diagnostic studies • Teach patients to care for their particular needs • Responsible for recognizing and interpreting symptoms and reporting condition of patients to the attending physician • Responsible for keeping inventory of stock medicines available and making drug and medical supply orders bimonthly or as needed • Administer treatments and medication under physician’ orders • Responsible for preparing in-house monthly reports as well as immunization report • Provide supervision of appropriate personnel, coordinate patient flow activities and assist with peer review of patient records in their quality of care system.

The Operations Manager reports to the Chief Operations Officer and will be responsible for overseeing the day-to-day management and operation of satellite clinic(s). The Operations Manager will implement the policies and procedures of the organization and work towards enhancing the development of clinic practices. Select, train, and supervise Health Center managers and employees. Assist in budget development and act as a liaison with local funding sources. Provide public relations representation at community functions and assist in the development and maintaining of corporate goals.

JOB OBJECTIVE
Under the general supervision of the Chief Business Development Officer, the Program Manager is
responsible for the overall direction, coordination, implementation, execution, control and completion of
varying Business Development projects ensuring consistency with company strategy, commitments and
goals. The Program Manager will manage multiple projects ensuring key objectives and project scopes
are met.  Plans and directs schedules as well as project budgets. Monitors the project from inception
through delivery. 

ESSENTIAL FUNCTIONS AND RESPONSIBLITIES 

The Program Manager will be responsible for the following: 
 Lead the planning and implementation of projects that are delegated or assigned by the CBDO.
 Manage multiple, ongoing Business Development project implementations to include the
definition of project scope, goals and deliverables.
 Define project tasks and resource requirements.
 Develop and maintain detailed project plan to include milestones, tasks, and target/actual dates
of completion.
 Assemble and coordinate project staff.  Schedule and conduct project meetings to include
logistics, agendas, and meeting minutes.
 Plan and schedule project timelines and revise as appropriate to meet changing needs and
requirements.
 Track project deliverables using appropriate tools. Prepare and submit project status reports to
management and all stakeholders.
 Provide direction and support to project team.
 Implement project changes and interventions to achieve project goals.
 Conduct project evaluations and assessment of results.  Facilitate post implementation review
meetings.
 Research new programs, standards, regulations and other information. 
 Perform other duties as assigned including participation in all safety programs which may include
assignment to an emergency response team. 

**Combination of remote days and 2 days a month onsite Ventura ,CA **

Under general supervision, performs a prospective HCC coding, researching and extracting potential chronic conditions from physician records, hospital records, laboratory and radiology records for Primary Care Physicians to review, treat and report. Performs a retrospective review, read and analyze physicians’ notes to assess them for documentation accuracy. Development of documentation examples to aid physicians. Identify trends where clinical documentation improvement areas and areas of opportunities. Provides provider education. Assess and recommend provider performance report cards and training to support efforts to optimize efficiencies and continuous process improvements.

The Risk Adjustment Coder is responsible for the following:

• Comply with organization’s policies and capable of following directions.
• Prioritize tasks, collaborative work environment.
• Performs an ongoing prospective and retrospective chart reviews.
• Analyzes and deciphers clinical linguistics and medical terminologies to assign appropriate ICD-10 CM does.
• Perform chart audits.
• Identify trends in area of clinical documentation inconsistency, insufficiency and discrepancy.
• Build a trustful rapport with providers.
• Effectively communicate clarifications with providers through task query.
• Provider education on clinical documentation improvement efforts.
• Attention to details impacts accuracy in data validation and quality data analysis.
• Development of hierarchical condition category (HCC) tools and resource materials utilizing scientific evidenced-base medicine.
• Compliance with CMS, OIG, The Joint Commission, and other government regulations and guidelines
• Audits daily encounters to ensure clinical documentations are clear, consistent, concise and completed supported with the monitoring, evaluate, assessment and treatment (M.E.A.T.) or treatment, assessment, monitoring or medicate, plan, evaluate, and referral (T.A.M.P.E.R.™) components and data validation prior to claim submission.
• Track HCC data validation.
• Collaborate with multidisciplinary teams.
• Quantitative analysis data-driven by HCC ICD-10 CM and HCC category count.
• Quality analysis data-driven by HCC validation statuses where areas of improvements and opportunities can be identified.
• Ad Hoc Review.
• Streamlining workflow processes and collaboration with multidisciplinary teams.
• Other duties and tasks as assigned to identify continuous process improvement workflows.

Under the general supervision of the Compliance Officer, the Risk Manager will be responsible for the management of a comprehensive health and safety risk management program.  The Risk Manager will identify and manage potential risks and liabilities within the organization and develop appropriate procedures and processes to help mitigate those risks. 

ESSENTIAL FUNCTIONS AND RESPONSIBLITIES

The Risk Manager will be responsible for the following:

• Establish appropriate structures and processes in relation to risk reporting, incident management, and health and safety within Clinicas.
• Coordinate the development and review of relevant/required risk and incident management policies, procedures and guidelines.
• In conjunction with appropriate staff, assist in identification of potential risk through risk assessment, analysis of accidents/incidents and near miss incidents, periodic safety inspections and/or audits.
• Educate and train staff about potential risks.
• Develop and support systems and processes for incident management including communication and escalation of serious incidents (internally and to external agencies as applicable).
• Make recommendations to reduce, prevent or eliminate risks identified.
• Maintain a risk audit database and liaise with department heads in relation to issues arising
• Keep up to date with health & safety legislation and guidelines.
• Work with legal counsel in situations of filed claims (as applicable).
• Collect and analyze data to identify problems or vulnerabilities in Clinicas procedures.
• Perform other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.

Under the general supervision of the Quality and Utilization Management Director, the Utilization Management Nurse performs case review and first level determination approvals for inpatient, outpatient, and ancillary services requests.  Reviews include benefit determination, medical appropriateness, and medical necessity determination requiring clinical judgment, critical-thinking skills, and detailed knowledge of departmental procedures and clinical guidelines.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

The UM Nurse’s responsibilities include, but are not limited to:

• Conduct clinical review for service requests for medical appropriateness and medical necessity using considerable clinical judgment, independent analysis, critical-thinking skills, and detailed knowledge of medical policies, clinical guidelines, and benefit plans.
• Review, triage, and prioritize authorization requests to meet required turn-around times.
• Expedite access to appropriate care for members with urgent or immediate needs using the expedited review process.
• Research member issues and assess member needs.
• Acquire appropriate clinical records, clinical guidelines, policies, EOC and benefit policy. Accurately applies coding guidelines.
• Develop determination recommendations and present cases to Medical Director (or designee) for potential denial determinations or when Medical Director input is needed.
• Interact with the providers or members as appropriate to communicate determination outcomes in compliance with state, federal and accreditation requirements.
• Develop and/or review appropriate documentation and correspondence reflecting determination. Ensure documentation is accurate, complete and conforms to established regulatory standards.
• Document all activities as per unit practice including entry into automated systems. Recognizes potential quality of care concerns and refers as appropriate.
• Make appropriate referrals to California Children’s Services (CCS) and Tri-Counties Regional Center (TCRC).
• Identify and refer members who may benefit from disease management or case management and make appropriate referrals.
• Manages out of area cases/requests based on current policy and refers them to the primary insurer as appropriate.
• Attend meetings or meet with staff at various health centers as assigned.

Perform other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.