Qureos Mentor

Astrana Health

<div><h3 class="jobSectionHeader"><b>Description</b></h3><div><br>
We are seeking an Actuarial Senior Analyst who thrives on independent thinking and enjoys building models and analyses from the ground up. This role offers the opportunity to leverage your healthcare and actuarial expertise to contribute to our leading position in the value-based care revolution. This role will report to the Senior Manager, Actuary and is open for remote work.<br>
<br>
Our Values:</div><ul>
<li><i>Put Patients First</i></li>
<li><i>Empower Entrepreneurial Provider and Care Teams</i></li>
<li><i>Operate with Integrity &amp; Excellence</i></li>
<li><i>Be Innovative</i></li>
<li><i>Work As One Team</i></li></ul><br>
<h3 class="jobSectionHeader"><b>
What You'll Do</b></h3><br>
<ul>
<li>
Reserving: Develop and maintain actuarial models to estimate liabilities for Incurred but Not Paid (IBNP) claims across all lines of business (Medicare, Medicaid, and Commercial).</li>
<li>Financial Planning and Analysis: Support budgeting and forecasting by maintaining and improving P&amp;L models and forecasting tools, as well as developing new tools to identify emerging trends and improve predictive accuracy.</li>
<li>Cost Trend Evaluation: Manage the Actuarial Trend Model used in operational and financial decision-making and analyze healthcare utilization patterns and cost trends to identify areas for improvement and opportunities for cost savings.</li>
<li>Actuarial Studies: Develop actuarial studies relating to items such as seasonality, high claim predictive modeling, trend, and inventory levels.</li>
<li>Audit and Reporting: Maintain, develop, and create ad hoc audit documentation in support of a public company, adhering to SOX compliance standards.</li>
<li>Infrastructure Development: Build robust analytical infrastructure, including comprehensive reports and dashboards, to monitor expense experience.</li>
<li>Cross-Functional Collaboration: Work closely with teams across ACO, Analytics, Data, Finance, M&amp;A, Contracting, Medical Economics, and Operations.</li>
<li>Ad Hoc Analysis: Support a fast-growing company with diverse actuarial projects and requests as they arise.</li>
<li>Other duties as assigned.</li></ul><br>
<h3 class="jobSectionHeader"><b>
Qualifications</b></h3><br>
<ul>
<li>
FSA or ASA credentials or near attainment of ASA credentials.</li>
<li>3+ years of experience in actuarial roles.</li>
<li>1+ years of experience in VBC or VBC adjacent roles</li>
<li>Advanced knowledge of Microsoft Excel.</li>
<li>Intermediate knowledge of SQL.</li>
<li>Proficiency and desire to build actuarial models from scratch.</li>
<li>Comfortable working on a small team in a fast-paced environment.</li>
</ul><div>Preferred Qualifications:</div><ul>
<li>Understanding of the actuarial continuum (both pricing/forecasting and valuation/reserving).</li>
<li>Experience with a variety of different LOBs.</li>
<li>Experience producing public financial reports.</li>
<li>Experience working on the provider side of healthcare.</li>
<li>Experience with Databricks, Python.</li>
<li>Experience in the California healthcare market.</li>
<li>Champion of independent critical thinking, unafraid to challenge the status quo and explore innovative solutions.</li></ul><br>
<h3 class="jobSectionHeader"><b>
Environmental Job Requirements and Working Conditions</b></h3><br>
<ul>
<li>
This position has the option to be remotely based in the U.S. Conversely, candidates can choose to work in a hybrid fashion and work through the Alhambra, CA, Las Vegas, NV, or Houston, TX Astrana Health offices.</li>
<li>The hiring manager for this role sits in the Eastern Time Zone, while many of the business partners work on Pacific Time.</li>
<li>The total compensation target pay range for this role is: $100,000 &ndash; $135,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.</li>
<li>Astrana Health offers a competitive Actuarial Student Program for any candidate seeking their ASA or FSA credentials.</li>
</ul><div>Astrana is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.<br>
</div><div>
<br>
Additional Information:<br>
</div><div>
<br>
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change</div><br>
<h3 class="jobSectionHeader"><b>
About Astrana Health, Inc.</b></h3><div>
Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.</div><div>
</div><div>
Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.</div></div>

Sr. Analyst - Actuary

<div><h3 class="jobSectionHeader"><b>Description</b></h3><div><br>
The IT Support Analyst I position serves as the initial point of contact for technical support needs within the IT Department. This role is well-suited for individuals with up to 2 years of experience in medium to large-sized firms' IT Departments (300 users or more). While experience in the Healthcare Industry is preferred, it is not a mandatory requirement.<br>
<br>
<b>Our Values:</b></div><ul>
<li><i>Put Patients First</i></li>
<li><i>Empower Entrepreneurial Provider and Care Teams</i></li>
<li><i>Operate with Integrity &amp; Excellence</i></li>
<li><i>Be Innovative</i></li>
<li><i>Work As One Team</i></li></ul><br>
<h3 class="jobSectionHeader"><b>
What You'll Do</b></h3><br>
<ul>
<li>
Provide prompt and effective first-level technical support for various IT incidents.</li>
<li>Collaborate with internal technical support and engineering teams on projects and support cases.</li>
<li>Handle incoming helpline calls and tickets, offering initial technical assistance before escalations.</li>
<li>Convey intricate cases and project tasks to Tier II and/or III support teams.</li>
<li>Offer field support in the absence of dedicated field support engineers.</li>
<li>Participate in a rotation to provide after-hours on-call support, a mandatory requirement for all Tier I staff.</li>
<li>Fulfill on-call duties by delivering remote assistance and support during the designated times.</li>
<li>Proactively review event logs related to systems, networking, and security, contributing to the support team's effectiveness.</li>
<li>Ensure compliance with SOX 404B and HIPAA rules and regulations as defined in policies.</li>
<li>Maintain open communication about any issues with scheduled maintenance tasks to IT Management.</li>
<li>Educate users on technologies, cybersecurity, and safeguarding company assets.</li></ul><br>
<h3 class="jobSectionHeader"><b>
Qualifications</b></h3><br>
<ul>
<li>
Bachelor&rsquo;s degree in Computer Science or Information Systems, OR 0 &ndash; 2 years of IT Technical Support experience in medium to large-sized firms.</li>
<li>Entry-level certifications in networking, infrastructure systems, and/or security.</li>
<li>Strong technical speaking and writing skills.</li>
</ul><div>
<br>
<b>You're great for this role if:</b>
</div><ul><li>You are proficient in troubleshooting basic PC performance issues and adhering to configuration protocols for user devices.</li>
<li>You have advanced skills in Microsoft Windows Operating Systems for endpoint computing.</li>
<li>You have strong written and verbal communication skills in English.</li>
<li>You thrive in a fast-paced healthcare environment with exceptional efficiency.</li>
<li>You are capable of self-initiating and contributing effectively to projects.</li>
<li>You demonstrates excellent interpersonal skills across all levels of the organization.</li>
<li>You are eager to learn and pick up new technologies quickly.</li>
<li>You are able to assist with scheduled and unscheduled tasks during emergency situations.</li></ul><br>
<h3 class="jobSectionHeader"><b>
Environmental Job Requirements and Working Conditions</b></h3><br>
<ul>
<li>
This position is required to be in office 5 days a week at 8880 W Sunset Rd, Suite 320, Las Vegas NV 89148</li>
<li>The target pay range for this role is: $26 - $33/hr. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.</li>
</ul><div>
<br>
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.<br>
</div><div><b>Additional Information:</b></div><div>
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.</div><div></div><h3 class="jobSectionHeader"><b><br>
About Astrana Health, Inc.</b></h3><div>
Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.</div><div>
</div><div>
Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.</div></div>

IT Support Analyst I

<div><h3 class="jobSectionHeader"><b>Description</b></h3><div><br>
<b>
About the Role:
</b><br>
We are currently seeking a highly motivated Claims Manager. This role will report to the AVP - Claims Operations and enable us to continue to scale in the healthcare industry.</div><h3 class="jobSectionHeader"><b><br>
What You'll Do</b></h3><br>
<ul>
<li>
Responsible for quality and performance metrics of processing teams that are assigned</li>
<li>Collaborate with other Teams as directed that are newly contracted and need to be implemented</li>
<li>Manage claims inventory to minimize claims turnaround times and ensure contractual SLAs are met</li>
<li>Drive continuous improvement efforts to improve claims quality and efficiency</li>
<li>Resolve processing/system issues within assigned department and across all IPAs</li>
<li>Prioritize work volumes on a daily basis</li>
<li>Oversee status of production in assigned department to ensure production and quality goals are being met</li>
<li>Analyze impact of new implementations on assigned department and reallocate staff duties as necessary</li>
<li>Onboard a large IPA that has global risk to ensure a successful implementation addressing and working with run out for the group, ensure accuracy, timeliness and meeting all regulatory requirements for a smooth transition</li>
<li>Training off-shore staff to take on a large IPA that is completely new to the organization and ensuring that there are no issues of non-compliance inaccuracies or problems that are brought to the attention of Astrana-This is a huge lift considering the volume of membership, claims run-out responsibility and ensuring there is no lapse in their claims adjudications and payment processes moving forward</li>
<li>Utilize claims management systems to provide reports and analysis to management on a regular basis</li>
<li>Develop team members to ensure accountability for achievement of departmental goals and objectives</li>
<li>Update and facilitate implementation of process and workflow modifications to improve operational efficiency</li>
<li>Educate and train claims employees on the overall claims process and best practices for successful outcomes</li>
<li> Address claim inquiries and claim payments by sensitive providers and members</li>
<li>JOC meetings-attendance and corrective action response when required</li>
<li>System updates maintaining the integrity of the Claims Payment Database; working inter-departmentally with other managers</li>
<li>Off-site Seminars IE: E-Z Cap and HMO Regulatory training.</li>
<li>High level grievances or claim reconsideration request for reimbursable claim reviews as needed</li>
<li>Evaluate trends in compliance findings to determine root cause and work with Director on remediations such as IDNs, EOBs, and all other findings that need to be addressed with the claims teams or Senior Leadership</li>
<li>Address non-compliance to Departmental standards with the examiners to include disciplinary actions, PIPs, Training plans and coaching</li>
<li>Job Descriptions- format a standardized Claim Department Organizational Chart outlining performance responsibilities and requirements for each position</li>
<li>Performance evaluation- monitors track and documents the annual performance evaluation of each Claim Department staff</li>
<li>Recruit monitor, and document the attendance, production and work quality of Claim Department staff to include employee counseling and/or termination in accordance with HRIS Guidelines</li>
<li>Staff analysis and growth potential</li>
<li>Maintain open and effective channels of communication between staff and management</li>
<li>Represent DMHC Regulatory and CMS Claims Payment Compliance issues at Management Meetings and with the Executive Board</li>
<li>Using all tools available ( IE: Industry Communications, Seminars, Internet, Professional Networking) to maintain the most current levels of understanding of trends, occurrences, ideology and law that will affect the operation, compliance and stability of the Claims Department and of Astrana</li>
<li>Communicate this information timely and effectively to both Claims Department Staff and to Management</li>
<li>Maintains the strictest confidentially at all times</li>
<li>Responsible for other miscellaneous assignments as requested by Management</li></ul><br>
<h3 class="jobSectionHeader"><b>
Qualifications</b></h3><br>
<ul>
<li>
Minimum of a Bachelor's degree (B. A.) from a four-year college or university; or four (4) years current Management or equivalent experience with an MSO or IPA Management</li>
<li>Full knowledge of DMHC, DHS and CMS Regulations and Guidelines, ICD-10, CPT, RV/RBRVS codes</li>
<li>Experience with contract law and Division Responsibility matrix interpretation</li>
<li>Comprehensive knowledge in the AB1455 regulations</li>
</ul><div><b>You're great for the role if:</b></div><ul><li>
EZCAP experience is a huge plus</li></ul><h3 class="jobSectionHeader"><b><br>
Environmental Job Requirements and Working Conditions</b></h3><br>
<ul>
<li>
Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Dr., Monterey Park, CA 91754.</li>
<li>The national target pay range for this role is $115,440.56 - $148,148.72. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.</li>
</ul><div>Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at <b>humanresourcesdept@astranahealth.com</b> to request an accommodation.
<br>
<br>
<b>Additional Information:</b>
<br>
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.</div><div></div><h3 class="jobSectionHeader"><b><br>
About Astrana Health, Inc.</b></h3><div>
Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.</div><div>
</div><div>
Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.</div></div>

Sr. Manager - Claims

<div><h3 class="jobSectionHeader"><b>Description</b></h3><div><br>
We are looking for a Nurse Practitioner / Physician Assistant to join a team that is passionate about the health of our patients. As part of the Quality Department, the Clinical Operations team leads the effort to improve health outcomes by coordinating and delivering key clinical care. Through outreach and education, we inspire patients to take a preventive approach to maintaining their health and to be active in their management of chronic diseases. Together, we strive to achieve healthy living for all through all stages of life. As a Nurse Practitioner / Physician Assistant, you will support Astrana members with education, preventative screenings, annual wellness visits and various other healthcare screenings. Through close collaboration with patients, you'll have the opportunity to positively influence behaviors that can lead to improved health outcomes. This full-time role entails conducting visits via telehealth video calls from your home office, with occasional in-clinic or home visits depending on the region.<br>
</div><div>Our Values:</div><ul>
<li><i>Putting Patients First</i></li>
<li><i>Empower Entrepreneurial Provider and Care Teams</i></li>
<li><i>Operate with Integrity &amp; Excellence</i></li>
<li><i>Be Innovative</i></li>
<li><i>Work As One Team</i></li></ul><br>
<h3 class="jobSectionHeader"><b>
What You'll Do</b></h3><br>
<ul>
<li>
Conduct annual wellness visits, patient education outreach, acute care follow ups, HRAs, medication review/reconciliation among other preventative services.</li>
<li>Document chief complaint, previous medical, family, and social history, review of systems, examination, assessment, and appropriate plan of care</li>
<li>Identify gaps in care during the evaluation that may require additional screening, diagnostics, and laboratory studies</li>
<li>Document all appropriate medical conditions to the highest level of specificity</li>
<li>Provide patient education regarding preventive services and prescribed treatments, reinforce the importance of staying current on covered preventive services</li>
<li>Make recommendations for member's follow-up with their primary care physicians</li>
<li>Communicate with coordination teams on follow up requests</li>
<li>Complete documentation/charting within one business day</li>
<li>Obtain and maintain a thorough understanding of Hierarchical Conditions Coding (HCCs) and HEDIS measure sets including criteria for compliantly closing each measure</li>
<li>Comply with federal, state, and local legal and professional requirements by studying existing and new legislation, anticipating future legislation; enforcing adherence to requirements; advising management on outstanding actions</li>
<li>Other duties as assigned</li></ul><br>
<h3 class="jobSectionHeader"><b>
Qualifications</b></h3><br>
<ul>
<li>
Active Nurse Practitioner Licensure, Active Nurse Practitioner Furnishing License OR Active Physician Assistant Licensure</li>
<li>Current Board Certification with (AANP, AACN, ANCC, NCCPA)</li>
<li>Valid DEA and NPI</li>
</ul><div>You&rsquo;ll be great for this role if you have:</div><ul>
<li>Minimum one year of direct patient care experience as a Nurse Practitioner OR Physician Assistant in Primary Care, Gerontology, or related field</li>
<li>Experience in HEDIS and HCC &bull; Fluency in Spanish or Mandarin</li>
<li>Experience with EHRs and navigating multiple systems.</li></ul><br>
<h3 class="jobSectionHeader"><b>
Environmental Job Requirements and Working Conditions</b></h3><br>
<ul>
<li>
Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 568 W. Garvey Ave., Monterey Park, CA 91754.</li>
<li>The total compensation target range for this role is between $140,000.00 - $150,000.00. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.</li></ul><br>
<h3 class="jobSectionHeader"><b>
About Astrana Health, Inc.</b></h3><div>
Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.</div><div>
</div><div>
Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.</div></div>

Telehealth Physician Assistant/Nurse Practitioner (Remote)

Join Astrana Health and explore 4   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Astrana Health

About Company

Sr. Analyst - Actuary

IT Support Analyst I

Sr. Manager - Claims

Telehealth Physician Assistant/Nurse Practitioner (Remote)