MSO VBC SPECIALIST I

The MSO Value-Based Care (VBC) Program Specialist I is responsible for providing support for the various Medicare and Medi-Cal VBC programs' performance and improvement activities that include facilitation of program implementation and monitoring of intervention activities, validation of data, and reporting of VBC program outcomes to contracted Health Plan(s).

They are required to be able to effectively communicate with a variety of professionals, including physician providers, health plan program administrators, and other NEMS internal departmental managers and staff, to promote effective program activities and achieve optimal program outcomes.

ESSENTIAL JOB FUNCTIONS:

• Participate in the various Medicare and Medi-Cal VBC programs and activities for inter-rater reliability studies, provider utilization studies, and other surveys and studies.
• Compile and review statistical data collected from medical records, logs, and database studies that support the VBC programs and improvement measures.
• Coordinate intervention activities as recommended and designed by the NEMS Practice Improvement Program (PIP) committee and monitor improvement outcomes.
• Perform outreach activities via phone, mail, email, and/or any other virtual platform as suited for the project to improve measurement outcomes.
• Identify and report to supervisor of all data integrity issues and opportunities for improvement; make recommendations to NEMS PIP Committee as desired.
• Compile reporting summaries and develop effective and optimal visual display to inform internal and external business partners about findings.
• Collaborate with physicians, staff, and external organizations on all VBC related program activities and communicate requirements implemented by Managed Care Plan(s).
• Participate in internal and external committees and prepares meeting materials as needed.
• Submit VBC program reports related to quality improvement and progress summaries to internal and external business partners as required in a timely manner.
• Performs other job duties as required by manager/supervisor.

• BA/BS Degree in Social Sciences, Business or General Education with minimum of 2 years’ experience working in healthcare setting. Associate Degree may be considered with relevant, equivalent work experience.
• Knowledge of managed care, Medi-Cal, Medicare, and HEDIS is strongly preferred.
• Must be PC literate - Strong Excel, Word, Power point, and Outlook skills; ability to perform data analysis and validation using spreadsheet program and/or other data visualization and analysis tools.
• Excellent communication skills (spoken and written).
• Knowledge of measurement tools and techniques including collection, aggregation, abstraction, validation, analysis, and reporting of data preferred.
• Knowledge and experience of managed healthcare in Medi-Cal, Medicare and other state-sponsored health programs is preferred.
• Knowledge of QI standards and regulatory requirements in HEDIS, CG-CAHPS, and HOS a plus.
• Prior experience in a managed care setting or IPA provider organization a plus.
• Detail oriented with ability to effectively manage time, see projects through to completion and organize competing priorities.
• Strong critical thinking and problem-solving skills to manage multiple levels of information and responsibilities, to quickly assess issues as they arise, and to develop timely and effective solutions.
• Strong interpersonal skills for collaborating effectively with a broad range of clinical and non-clinical staff.

LANGUAGE:

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

STATUS:

• This is an FLSA Non-exempt position.
• This is not an OSHA high-risk position.
• This is a Full Time 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).