Jobs at North East Medical Services (NEMS)

Coordinate patient care and discharge planning, develop individualized care plans, facilitate interdisciplinary case conferences, perform home visits and medication reconciliation, manage patients across case management programs, collaborate with providers and community resources, document case activities, support quality improvement, and train new case managers.

Lead and execute integrated, multi-channel marketing strategies to drive enrollment, engagement, revenue, and brand visibility. Manage marketing staff and external partners, oversee content, CRM and analytics, allocate budget and resources, report performance to leadership, and ensure cross-departmental alignment and brand governance.

Lead and execute organization-wide communications and PR strategy for NEMS. Manage media relations, draft press materials, own communications and social media calendars, coordinate press distribution, build media/influencer lists, monitor coverage and metrics, produce content to drive engagement and brand visibility, and present insights to leadership. Support stakeholder relationships and crisis or media inquiries. Bilingual English and Cantonese required.

Provides nurse-led case management and discharge planning for a caseload of patients, developing individualized care plans, coordinating interdisciplinary teams and community resources, performing home visits and medication reconciliation, and monitoring outcomes for utilization and quality improvement.

Build and maintain full-stack, scalable healthcare software using TypeScript, React, and NextJS. Design and integrate RESTful APIs and healthcare standards (FHIR, HL7), manage databases (Postgres, MS SQL), containerize with Docker, collaborate via Git/BitBucket, implement OAuth security patterns, and deliver production-ready, HIPAA-aware services.

Coordinate the end-to-end contract lifecycle for healthcare payer and service agreements: draft, review, route, track, execute, manage amendments/renewals, maintain contract system, liaise with legal, compliance, operations and partners, assist negotiations, escalate risks, and support stakeholders to ensure regulatory compliance and timely contract processing.

Under clinician supervision, review and process referral and treatment authorization requests, apply clinical guidelines, meet productivity targets, prepare complex cases for Medical Director review, perform care coordination and customer service, and ensure compliance with DHCS and health plan policies.

Manage provider credentialing and re-credentialing for a 1,000+ provider network, maintain accurate provider data, coordinate with health plans and internal teams, prepare audit files, support committee processes, monitor compliance, and handle credentialing-related complaints and appeals.

Provide intermediate-level implementation, configuration, support, and maintenance of Epic applications. Lead module implementations, troubleshoot issues, perform upgrades, develop training and documentation, run QA/testing, and collaborate with clinical, operational, and IT teams to optimize Epic workflows.

Lead and oversee managed care claims operations for Medi-Cal, Medicare Advantage, and PACE. Ensure regulatory compliance, optimize adjudication workflows, manage escalations and appeals, lead and train claims staff, collaborate with payers/providers/IT, analyze claims data, and report performance to senior management.

Reviews referral and treatment authorization requests, approves per authorization grid and clinical guidelines, leads and trains junior UM coordinators, prepares notices and reports, performs care coordination and transition-of-care, investigates appeals/complaints, communicates with providers and health plans, and ensures regulatory and contract compliance.

Sell Medicare Advantage and Prescription Drug plans by identifying Medicare-eligible prospects, conducting needs analyses and presentations, enrolling members, meeting sales goals, maintaining stakeholder relationships, ensuring CMS compliance, and staying current on Medicare regulations.

Provide implementation, configuration, first-level support, testing, training, and documentation for Epic applications. Work with clinicians, IT, and vendors to troubleshoot issues, ensure integrations, and support upgrades and quality assurance.

Supports HR department with onboarding, new hire orientation, I-9 completion, HRIS data entry and audits, benefits enrollment support, employee inquiries, background check processing, reporting, and general HR administrative tasks.

Coordinate and implement community health projects: develop plans and timelines, manage multiple initiatives, run meetings and presentations, gather healthcare data, support grant/budget/regulatory reporting, document workflows, and assist managers and physician leads.

Evaluate medical necessity and prior authorization requests for inpatient and outpatient care, conduct peer-to-peer reviews, support appeals, perform concurrent and retrospective chart reviews, analyze HCC coding and RAF scores, collaborate with care teams on utilization and quality improvement, and support risk adjustment, provider education, and initiatives to reduce readmissions and enhance patient safety.

Provides primary and acute care to PACE participants including history-taking, exams, diagnosis, medication prescribing and adjustments per protocols, documentation, referrals, participation in quality improvement, interdisciplinary meetings, outreach, and patient follow-up and health maintenance.

Provide nursing-led care coordination and discharge planning for assigned patients. Develop individualized care plans, facilitate interdisciplinary collaboration and case conferences, manage transitions of care and chronic/complex cases, perform home visits and medication reconciliation, identify community resources, support utilization management and quality improvement, document case activities, and assist in training new case managers.

Entry-level Epic Application Analyst supporting implementation, configuration, testing, training, and first-level support for Epic Tapestry in managed care operations. Collaborates with cross-functional teams, troubleshoots issues, documents processes, and participates in upgrades and QA. May work after-hours and weekends as needed.

Perform healthcare data research, analysis, and reporting focused on Epic Tapestry and managed care measures (HEDIS, P4P, HCC/RAF, PMPM). Develop BI reports/dashboards, present insights to stakeholders, handle ad hoc requests, and obtain required Epic and data-model certifications.