Fraud analyst Jobs in Beloeil, QC

About myPlace Health

myPlace Health was founded in 2021 by mission-aligned healthcare leaders and organizations that are committed to drastically improving health outcomes, quality and experience for vulnerable older adults and frail seniors. We specialize in providing value-based, comprehensive care and coverage for older adults with significant needs so they can thrive in the homes they love and in the communities they cherish.

Our mission is simple : to enable older adults to live the independent lives they deserve. We pursue this mission through our myPlace PACE (Program of All-Inclusive Care for the Elderly) model, which provides seamless primary care, integrated health plan coverage, personalized social engagement, and customized services delivered in the participant’s preferred place.

myPlace Health is building a mission-driven team that shares our passion for redefining the way older adults experience care as they “age in place” in the community. This is a unique opportunity to take on one of our country’s most challenging healthcare problems and join a fast-growing, dynamic team as we prepare to scale our mission to serve more markets.

About this Role

As a PACE Medical Director, you will play an integral role in supporting interdisciplinary care teams to achieve our mission of enabling seniors to live the independent lives they deserve. You will work closely with a group of care team members to provide high quality care and deliver an outstanding experience to all participants. The PACE Medical Director is responsible for oversight of day-to-day clinical operations at the assigned center(s) and is the accountable medical leader that oversees the results delivered by an assigned clinical team. The PACE Medical Director is ultimately responsible for the delivery and quality of participant care, for clinical outcomes, and for the implementation, as well as oversight, of the quality improvement program.

Expectations for this role

• Clinical Care and Oversight
• Ensure that evidence based high-quality, cost-effective care is provided to PACE program participants in accordance with the PACE program mission, current standards of medical practice, applicable regulatory requirements.
• Provide medical care to PACE participants, including the evaluation, diagnosis, and management of their medical conditions, including but not limited to taking medical history, performing biannual examinations, ordering and interpretation of diagnostic tests, formulating treatment plans, writing prescriptions, ongoing follow up of same, and management of medical information from specialists and hospital teams.
• Document medical care in the participant’s medical record, in compliance with PACE documentation policies.
• Recruitment, training, supervision and evaluation of employed physicians, advanced practitioners, and transitions of care coordinators.
• Training and oversight of contracted primary care physicians and advanced practitioners as well as contracted specialists.
• Quality and Utilization Management and Oversight
• Oversee the development and implementation of the Quality Improvement and Performance Improvement Program (QAPI) in collaboration with other key leaders and staff assigned to the market.
• Monitor utilization management trends, such as inpatient hospitalization and emergency room visits and set outcome targets.
• Develop interventions to support optimum health of participants including functional and quality of life, participant, and caregiver satisfaction through the efficient use of program resources and achievement of program goals.
• Ensure the completion of periodic chart audits for the purpose of monitoring in the areas of quality of care, compliance with PACE regulations, utilization plans, appropriate use of medications and identifying areas of risk.
• Ensure adequate primary care provider resources are available for staff to meet participant needs and regulatory requirements.
• Oversee provider after hours on call arrangements to ensure 24-hour provider availability with consideration of participant and provider satisfaction.
• Provide consultation and support for program staff regarding grievances, appeals and IDT decision making processes; evaluate medical related grievances that arise (unless a conflict of interest exists).
• Stay abreast of current literature and best practices and make recommendations to adjust policies and procedures as appropriate.
• Monitor quality of care provided by key contracted providers such as hospitals, SNFs and long-term care facilities.
• Develop collaborative relationships with community physicians and other providers to promote positive, effective working relationships and prospect referrals.
• Promote collaboration, accountability and continuing professional development of PACE primary care staff via regular group meetings, one on one sessions, and other strategies.
• Participate on the Quality committee and other committees or workgroups as needed.

Attributes of an Ideal Candidate

Location

250,000 - $300,000 a year

What's in it for you?

myPlace Health offers a robust compensation package for this role that includes cash compensation and other total rewards. Base pay is based on several factors including but not limited to education, relevant work and industry experience, certifications, and location of the role. Onsite roles include appropriate geographic adjustments, while remote roles are typically priced off national pay data.

Competitive Incentive Plan : Performance-based incentive plan that is beyond the industry standard. Preparing you for retirement : 401k with Employer match. Medical Plans to fit your needs : Your choice of 6 medical plans, with premium coverage of up to 80% for employees and 75% for all dependents. Ancillary benefits to meet your other needs : Dental and vision plans to meet your needs of you and your dependents; health savings account, flexible spending accounts, short- and long-term disability coverages, as well as basic life insurance. myPlace is also proud to offer accident, hospital indemnity, and critical illness benefits for our team. Generous time off : PTO starting at 20 days per year; plus 12 paid holidays per year, and 2 floating holidays per year. Professional Development top of mind : Generous CME / CEU budget and time off, and professional development opportunities. Making your home office comfortable : A one-time stipend towards setting up your home office, if applicable. Family friendly environment : Family friendly policies, including paid new parent leave and new child care stipend.

Your Application

Please submit your resume / CV.

Our Commitment to Diversity, Equity and Inclusion

At myPlace Health, we value the diversity of our team members, and we are committed to building a culture of inclusion and belonging. We pride ourselves to be an equal opportunity employer. People seeking employment at myPlace Health are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law.

COVID-19 Vaccination Policy

At myPlace Health, we provide safe and high-quality care to our participants. To achieve this, we have a policy that strongly recommends Covid-19 vaccination to keep both our team members and participants safe. Medical and religious exemptions can be granted based upon review of proper documentation. We adhere to all federal, state, and local regulations by obtaining necessary proof of vaccination prior to employment.

Beware of Scams and Fraud

Please beware of scams that solicit interviews or promote jobs for opportunities that are not listed on our website or are not directly related to a job you applied for yourself. Please be advised that myPlace Health will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission by selecting the ‘Rip-offs and Imposter Scams’ option : https : / / reportfraud.ftc.gov / # /

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