OPERATING SYSTEMS ARCHITECT

NORTH EAST MEDICAL SERVICES•Burlingame, CA

5d•$143,099 - $165,048

About The Position

The Managed Care Operating Systems Architect is responsible to design, integrate, and optimize the core operational systems that support managed care workflows. This role is focused on workflow automation, system integration, and scalable architecture to improve operational efficiency, data flow, and member engagement across the organization. The ideal candidate understands managed care operations end-to-end and can translate business needs into streamlined, automated, and interoperable system solutions that support members, providers, and internal teams.

Requirements

Possession of a four-year degree or higher from an accredited institution in a computer-related field; or equivalent experience.
Experience with integration platforms (e.g., iPaaS, middleware, event-based architecture).
Experience with cloud-based architecture and modern automation tools.
Knowledge of HL7/FHIR, ANSIX12 or other healthcare data standards.
Knowledge of MS-SQL Server 200x database maintenance and development.
LAN administration in Windows 200x Advanced Server, Active Directory, and Exchange Server 200x.
Working knowledge of State/Federal healthcare compliance requirements (HIPAA, AB1455, and ICE standards), particularly CMS & DHCS guidelines.
System Administrator knowledge of Microsoft Networking Operating Systems.
Must be able to fluently read, write and speak English.

Nice To Haves

Experience in value-based care or population health environments a plus.
Familiarity with care management, CRM, or member engagement platforms a plus.
Fluent in other languages is an asset.

Responsibilities

Design and evolve workflows within an enterprise operating system architecture that supports managed care functions such as member engagement, care management, utilization management, claims, provider and contract management.
Lead workflow automation initiatives to reduce manual processes, eliminate redundancies, and improve turnaround times across operational teams.
Architect and oversee system integrations between core platforms (e.g., claims, care management, CRM, data platforms, vendor solutions, and member-facing tools).
Collaborate with business stakeholders to map current-state and future-state workflows, identifying opportunities for automation and efficiency gains.
Ensure seamless data flow and interoperability using APIs, event-driven architectures, and integration platforms.
Partner with product, engineering, data, and operations teams to ensure solutions align with business goals and regulatory requirements
Support the development of member engagement capabilities, including personalized communication, self-service tools, and real-time data access
Establish architectural standards, integration patterns, and governance to ensure salability, security, and maintainability.
Evaluate and recommend technologies and vendors that enhance operational efficiency and member experience.
Monitor system performance and workflow outcomes, using metrics to drive continuous improvement.
Collaborates with NEMS IT and EHR teams to design and develop custom system interface(s) between the various NEMS applications.
Perform miscellaneous support tasks including IT special projects and/or NEMS administrative projects involving NEMS operations.
Performs other job duties as required by manager/supervisor.