Qureos Mentor

North East Medical Services

<div><p><b>SUMMARY OF POSITION:</b></p><p>
</p><p>Under the direct supervision of the Center Manager, the PACE Community Services Nurse is responsible for assessing medical level-of-care eligibility for prospective PACE enrollees, and for assessing and implementing a plan for community-based caregiving services. He/she is one of the first introductions for prospective PACE enrollees to the PACE Interdisciplinary Team (IDT) and works in partnership with the Enrollment Specialist to ensure a smooth and successful transition into the PACE program.
</p><p></p><p><b>ESSENTIAL JOB FUNCTIONS:</b></p><ul><li>
Completes level-of-care documentation and submits for review to the Department of Health Care Services (DHCS), initially for prospective PACE enrollees and as required annually for enrolled Participants.</li><li>
Presents prospective enrollee cases to the Interdisciplinary Team (IDT), as needed.</li><li>
Participates as an active member of the IDT for Participant care planning.</li><li>
Conducts comprehensive nursing assessments, reassessments, and in-home evaluations on prospective or enrolled PACE participants developing and documenting care plan services and/or enrollment recommendations.</li><li>
Coordinates with the IDT to develop an individualized in-home Care Plan.
</li><li>Collaborates with the Home Care Supervisor to oversee the implementation and continuation of care plan services in the participant&rsquo;s home.
</li><li>Ensures all participant changes are documented appropriately in the medical record and communicates participant changes to IDT in a timely manner.
</li><li>Assists with identifying qualifications and competency requirements for caregiving staff, and in providing training and competency checks.</li><li>
Supports family caregivers through health education and skills-training to ensure the Participant&rsquo;s care needs are met in a safe and timely manner.</li><li>
Collaborates with the Center Manager, Home Care Supervisor, and other IDT members to ensure the seamless and successful delivery of community-based services, both at onset and on an ongoing basis.</li><li>
Remains up to-date on home care standards and best practices.</li><li>
Provides effective leadership by coordinating and integrating services within the department, with other departments and with the IDT&rsquo;s primary functions.</li><li>
Provides care to participants in-person, via telehealth, and/or via telephone, as indicated.</li><li>
Provide home health as needed.
</li><li>Utilize Epic appropriately and efficiently and serve as content and workflow expert for resolving issues and proposing solutions in Epic</li><li>
Performs other job duties as required by manager/supervisor.</li><li>
May provide after-hours on-call coverage to support PACE participants when the PACE Center is closed as needed.
</li></ul><p></p><p><b>QUALIFICATIONS:</b></p><p>
</p><p><b>Required:</b></p><ul><li>
Valid unrestricted California RN license.</li><li>
Graduate of an accredited school of Nursing.</li><li>
Current BLS and First Aid required
</li><li>Valid CA driver license (no violations within the last 5 years)
</li></ul><p></p><p><b>Preferred:</b></p><ul><li>
Bachelor&rsquo;s degree or higher in Nursing (BSN/MSN)</li><li>
Certificate in Public Health Nursing (PHN)</li><li>
At least two years&rsquo; nursing experience, preferably in community-based or home health nursing.</li><li>
Experience in conducting home visits</li><li>
Additional training and/or certification in geriatrics.</li><li>
At least one year of experience working with a frail and/or older adult population.</li></ul><p>
</p><p><b>LANGUAGE:</b></p><p>
</p><ul><li>Must be able to fluently speak, read and write English.</li><li>
Fluency in Chinese (Cantonese) and/or Vietnamese is required.</li><li>
Fluency in other languages is an asset.<b>
</b></li></ul><p></p><p><b>STATUS:</b></p><p>
</p><p>This is an FLSA non-exempt position.</p><p>
This is not an OSHA high-risk position.</p></div><p></p>

PACE COMMUNITY SERVICES RN

<div><div><div>The Clinical Data Scientist serves as a strategic bridge between clinical operations, Epic analytics and research initiatives at NEMS. This role will design, build, and validate reproducible analytical workflows and machine learning models using clinical and real‑world data (EHR, claims, registries) to answer clinical and operational questions, support research and product development, and enable data‑driven decision making across the organization.</div></div><p>
</p><div><div><b>ESSENTIAL JOB FUNCTIONS:</b></div></div><p>
</p><ul><li><div>Acts as liaison between IT, clinical informatics, operations and research teams to ensure alignment on clinical data strategy</div></li><li><div>
Designs and executes study and analysis plans for clinical research, outcome measurement, and predictive modeling.</div></li><li><div>
Analyzes patient populations to identify care gaps, utilization patterns, and opportunities for preventive interventions</div></li><li><div>
Supports value-based care initiatives by calculating and monitoring quality measures that impact reimbursement and funding</div></li><li><div>
Collaborates with care management, population health and other operational teams where needed to optimize provider engagement, patient engagement and outreach campaigns</div></li><li><div>
Partners with interdepartmental leaders, clinical directors and quality teams to gather requirements and prioritize analytics projects</div></li><li><div>
Serves as SME for analytics team; validates clinical workflows and data definitions</div></li><li><div>
Extracts, cleans, harmonizes, and curates clinical and real‑world datasets (EHR, claims, labs, device data), ensuring provenance and reproducibility.</div></li><li><div>
Develops feature engineering pipelines and statistical or machine‑learning models (risk scores, phenotyping algorithms, prognostic/predictive models)</div></li><li><div>
Validates models using appropriate methods (cross‑validation, temporal validation, external cohorts) and assesses fairness, calibration, and clinical utility</div></li><li><div>
Collaborates closely with clinicians, biostatisticians, product managers, and engineers to translate clinical questions into analytic specifications and actionable outputs</div></li><li><div>
Implements production‑ready pipelines and supports model deployment, monitoring, and lifecycle management (versioning, performance tracking, drift detection)</div></li><li><div>
Ensures compliance with data governance, privacy, and security requirements (HIPAA best practices); participates in data access and IRB processes as needed</div></li><li><div>
Produces clear, reproducible documentation, analysis code, technical reports, and visualizations for both technical and non‑technical stakeholders</div></li><li><div>
Contributes to team best practices: code review, unit/integration testing for analytics code, and reproducible research practices (notebooks, containers, CI/CD)</div></li><li><div>
Tracks project timelines, deliverables and stakeholder satisfaction metrics using project management tools &ndash; Jira or similar</div></li><li><div>
Performs other job duties as required by manager/supervisor</div></li></ul><ul><li><div>
Clinical Degree: MD, DO, NP, PA, PharmD, or equivalent clinical training with active understanding of clinical workflows, diagnoses, and treatment protocols preferred</div></li><li><div>
MS in Data Science, Biostatistics, Epidemiology, Computer Science, Biomedical Informatics, or related quantitative discipline (or equivalent experience or related field).</div></li><li><div>
5+ years&rsquo; experience working with clinical or real‑world healthcare data (EHR, claims, registries) in applied analytics or research settings</div></li><li><div>
Experience working with underserved or immigrant populations; cultural competency and multilingual skills highly valued</div></li><li><div>
Epic Certification required or must obtain within 6 months of hire</div></li></ul><p>
</p><div><div><b>Technical Skills and Competencies</b>:</div></div><ul><li><div>
Data Visualization tools (Power BI, Tableau or similar)</div></li><li><div>
Strong programming skills in Python and/or R; proficiency with SQL for large‑scale data extraction and manipulation</div></li><li><div>
Deep understanding of quality measures (HEDIS, eCQM), value-based care models and population health principles</div></li><li><div>
Experience with healthcare data standards and APIs (FHIR, HL7) and common EHR systems (Epic, Cerner) preferred</div></li><li><div>
Strong analytical rigor and attention to detail</div></li><li><div>
Excellent written and verbal communication skills with experience presenting technical results to clinicians and stakeholders</div></li><li><div>
Proactive problem solver with a bias for reproducible, production‑quality work</div></li><li><div>
Comfortable with ambiguity and rapidly evolving requirements in healthcare settings</div></li></ul><p>
</p><div><div><b>LANGUAGE:</b></div></div><p>
</p><ul><li><div>Must be able to fluently speak, read and write English</div></li><li><div>
Fluent in Chinese (Cantonese and/or Mandarin), Vietnamese, Spanish and other languages preferred</div></li><li><div>
Fluency in other languages are an asset</div></li></ul><p>
</p><div><div><b>STATUS:</b></div></div><p>
</p><ul><li><div>This is an FLSA Exempt position.</div></li><li><div>
This is not an OSHA low-risk position.</div></li><li><div>
This is a Full Time position.</div></li></ul><p>
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.</p><p>
NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).<br>
</p><p>#LI-DNI</p></div>

CLINICAL DATA SCIENTIST

<div><p><b>SUMMARY OF POSITION:</b><br>
</p><p>The Patient Account Specialist I interprets EOBs for correct payment verification, adjustments, and denials. The Patient Account Specialist I is also responsible for handling outstanding claims on aging reports and resolving patient inquiries regarding billing statements and insurance overage-related matters. The Patient Account Specialist I has to maintain up-to-date knowledge about CPT, ICD-10 CM, billing regulations, and payers' requirements. The Patient Account Specialist I has to comply with HIPAA guidelines and maintain confidentiality regarding patient account status and the organization's financial affairs.</p><p>
</p><h1 class="jobSectionHeader"><b>ESSENTIAL JOB FUNCTIONS:</b></h1><ul><li>
Reviews, edits, processes, and submits <b>electronic and hardcopy claims</b> to various payers (Medicare, Medicaid, Managed Care, and Private Insurance) for <b>FQHC (Federally Qualified Health Centers)</b> and <b>FFS (Fee-For-Service)</b> reimbursement, ensuring accuracy of payment entries and completeness of charge capture information.</li><li>
Maintains up-to-date knowledge of <b>medical billing requirements</b> for FQHC Medi-Cal, Medicare, state, local programs, and private insurance payers.</li><li>
Reports issues or payment trends (e.g., charges applied to the wrong visit, incorrect billing codes) to the supervisor for resolution.</li><li>
Edits charge/claim details and corrects submission errors to ensure accuracy.</li><li>
Researches and resolves outstanding claims on <b>aging reports</b> to minimize delays in reimbursement.</li><li>
Responds to <b>payer requests and remittance advices</b> promptly and professionally, including phone calls, letter responses, appeals, and submission of medical records or additional information as required.</li><li>
Under the guidance of the <b>Patient Account Specialist II</b>, addresses patient inquiries and billing complaints by making necessary adjustments, exploring all options to secure claim payments, referring complex issues to appropriate staff, and ensuring proper follow-up.</li><li>
Posts charges and submits claims for <b>NEMS physicians&rsquo; hospital visits</b>.</li><li>
Provides <b>training and support</b> to the Billing Department and front desk staff in Member Services, Medical, Dental, Optometry, Laboratory, and Radiology Departments.</li><li>
Adheres to policies and procedures for <b>billing records retention</b>.</li><li>
Acts as a <b>liaison</b> between physicians, insurance companies, and third-party organizations by processing and verifying invoices, ensuring claim reimbursements, and auditing patient accounts.</li><li>
Performs additional duties as assigned by management.</li></ul><h1 class="jobSectionHeader"><b>
</b></h1><p></p><ul><li>Completion of an AA/AS degree is required, and a 4-year university diploma is preferred or maybe substituted with a minimum of 3 years of work experience in healthcare.
</li><li>Working experience in a healthcare or FQHC setting is preferred</li><li>
Working experience with Epic PB Resolute is preferred</li><li>
Familiar with Medicare, Medicaid, Private insurances, Managed Care (HMO &amp; PPO), CPT, and ICD-10 CM</li><li>
Must have excellent analytical and communication skills</li><li>
Must be proficient in computer skills</li><li>
Ability to write business correspondence</li><li>
Strong organizational skills to coordinate multiple, varied billing processes simultaneously</li><li>
Upholds high customer service standards in a demanding and complex health care organization</li><li>
Demonstrates initiative, resourcefulness, integrity and dedication to timeliness to achieve high customer satisfaction levels</li>
Self-motivated, diligent, organized, resourceful, responsible, and enthusiastic<br>
<li>
</li></ul><p><b>LANGUAGE:</b></p><ul><li>
Proficient in written and spoken English and Chinese (Cantonese and/or Mandarin)</li>
Fluent in other languages is an asset<br>
<li>
</li></ul><p><b>STATUS:</b></p><ul><li>
This is an FLSA Non-exempt position.
</li><li>This is not an OSHA high-risk position.</li>
This is a Full Time position.<br>
<li>
</li></ul><p>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.</p><p>
NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).</p></div>

PATIENT ACCOUNT SPECIALIST I

Join North East Medical Services and explore 3   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.

North East Medical Services

About Company

PACE COMMUNITY SERVICES RN

CLINICAL DATA SCIENTIST

PATIENT ACCOUNT SPECIALIST I