Telesales Retention Representative
External Description:
Telesales / Retention Representative
Looking for an enthusiastic Telesales/Retention Representative who will be responsible for generating leads to meet and exceed individual sales production of new enrollments and help retaining existing members within company health plan(s). The ideal candidate must be friendly, professional and genuinely interested in the needs of our prospects/members to proactively address various customer related needs.
The Telesales Representative reports to the Telesales Manager.
General Duties/Responsibilities:
(May include but are not limited to)
Responsible for meeting and exceeding monthly goal and retention of existing members.
Handle inside/in-bound telephone inquiries from prospective members, providers, and other community partners seeking information regarding all lines of business
Direct prospects to the field sales team when needed
Conduct outbound calls relevant to enrollment/disenrollment campaigns, requests for information from community events, provider offices, after-hour messages, and website inquiries
Submit daily activity production reports and/or monthly reports as required.
Ensure that information and assistance provided is within the standards established by all applicable federal /state laws and regulations and Alignment Health Plan's Compliance Department
Understanding of new updates related to company and/or CMS and marketing guidelines required.
Participate with competitor analysis (SWOTs) Strength, Weakness, Opportunities and Threats within respective market(s) and/or territories as required by management.
Support other projects within the Sales and Marketing Department as directed by the Management Team
Must be a team player, share best practices, and attend staff meetings and sales trainings when required.
Other duties may be assigned.
Supervisory Responsibilities:
This position has no direct employee supervisory responsibilities.
Minimum Requirements:
Minimum Experience:
Strong knowledge and understanding of the CMS Marketing Guidelines.
Medicare Health Plan knowledge and/or health insurance sales background preferred.
Minimum of 1 year of inside business to consumer sales experience and/or clinical and/or community outreach; Telesales experience using call center scripts highly desirable
Education/Licensure:
Must have and maintain active Health/Accident/Life insurance license within respective selling states, currently CA (required), NC, and FL (preferred).
Other:
Bilingual
Flexibility with schedule depending on needs
A self-starter who is a team player and extremely organized.
Ability to learn plans and describe/explain them to prospects
Excellent communicator and presentation skills.
Solid computer skills (Word, Excel and PowerPoint).
Essential Physical Functions:
While performing the duties of this job, the employee is regularly required to talk and listen. The employee regularly is required to sit for long period of time during Annual Enrollment Period.
City: Orange
State: California
Location City: Orange
Schedule: Full Time
Location State: California
Community / Marketing Title: Telesales / Retention Representative
Company Profile:
Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.
By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.
EEO Employer Verbiage:
On August 17, 2021, Alignment implemented a policy requiring all new hires to receive the COVID-19 vaccine. Proof of vaccination will be required as a condition of employment subject to applicable laws concerning exemptions/accommodations. This policy is part of Alignment's ongoing efforts to ensure the safety and well-being of our staff and community, and to support public health efforts. Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran. If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact ******************.
$59k-67k yearly est. Easy Apply 60d+ ago
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SNP Case Manager (TEMPORARY)
Alignment Healthcare 4.7
Alignment Healthcare job in Orange, CA
Case Manager, SNP
External Description:
The SNP Case Manager is responsible for health care management and coordination, within the scope of licensure, for members with complex and chronic care needs. The SNP Case Manager delivers care to members utilizing the nursing process and effectively interacts with members, care givers, and other interdisciplinary team participants. The Case Manager will assist with closing gaps in care and resolving barriers that prevent members from attaining improved health.
The SNP Case Manager will connect with members telephonically.
General Duties/Responsibilities:
(May include but are not limited to)
1. Coordinate care by serving as a resource for the member, their family and their physician.
2. Ensure access to appropriate care for members with urgent or immediate needs facilitating referrals/authorizations within the benefit structure as appropriate.
3. Complete comprehensive assessments within their scope of practice that includes assessing the member's current health status, resource utilization, past and present treatment plan and services.
4. Collaborates with the member, the PCP and other members of the care team to implement a plan of care.
5. Interfaces with Primary Care Physicians, Hospitalists, Nurse Practitioners and specialists on the development of care management treatment plans.
6. Provide education and self-management support based on the member's unique learning style.
7. Assists in problem solving with providers, claims or service issues.
8. Works closely with delegated or contracted providers, groups or entities to assure effective and efficient care coordination.
9. Maintains confidentiality of all PHI in compliance with state and federal law and Alignment Healthcare Policy.
Supervisory Responsibilities:
None.
Minimum Requirements:
1. Minimum Experience:
a. 1-3 years clinical experience, 2 or more years of case management experience; or any combination of education and experience, which would provide an equivalent background.
b. Health Plan experience preferred
2. Education/Licensure:
a. Must have and maintain an active, valid, and unrestricted RN or LVN license in the state for which you are applying
3. Other:
a. Possess a high level of understanding of community resources, treatment options, home health, funding options and special programs
b. Extensive knowledge of the management of chronic conditions
c. Excellent verbal and written communications skills
d. Team player who builds effective working relationships
e. Ability to work independently
f. Experience using standardized clinical guidelines required
g. Strong organizational skills
h. Ability to operate PC-based software programs including proficiency in Word, Excel and PowerPoint
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
City: Orange
State: California
Location City: Orange
Schedule: Full Time
Location State: California
Community / Marketing Title: SNP Case Manager (TEMPORARY)
Company Profile:
Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.
By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.
EEO Employer Verbiage:
On August 17, 2021, Alignment implemented a policy requiring all new hires to receive the COVID-19 vaccine. Proof of vaccination will be required as a condition of employment subject to applicable laws concerning exemptions/accommodations. This policy is part of Alignment's ongoing efforts to ensure the safety and well-being of our staff and community, and to support public health efforts. Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran. If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact ******************.
$60k-76k yearly est. Easy Apply 60d+ ago
Director, RADV Audit Operations
Alignment Healthcare 4.7
Alignment Healthcare job in Orange, CA
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
The Director of RADV Audit Operations is responsible for managing and overseeing the tactical and opera-tional aspects of the RADV audit process, including medical record retrieval, coding validation, and audit logistics. This role ensures compliance with CMS timelines, quality standards, and cross-department coordination for all RADV-related operational activities at Alignment.
Job Responsibilities:
Process management: Leading all phases of the audit process, including data sample validation, medical record retrieval, coding abstraction, quality assurance auditing and submission to CMS.
Strategy and planning: Responsible for developing and implementing strategies to improve overall coding accuracy and documentation integrity, which mitigates future audit risk.
Cross-functional collaboration: Working closely with other departments-such as IT, Risk Adjustment Operations, Provider Relations, and Compliance-to ensure accurate data submission and a smooth audit process.
Oversee medical record retrieval processes, ensuring HIPAA compliance and timely submissions.
Manage teams of auditors, coders, and project managers to execute end-to-end CMS RADV workflows.
Coordinate with vendors and internal partners for coding reviews and documentation validation.
Ensure the accuracy and completeness of HCC submissions during RADV cycles.
Track progress and performance metrics; escalate risks to leadership as needed.
Develop and maintain standard operating procedures (SOPs & P&Ps) for audit workflows.
Monitors coder and physician audit results to maintain quality of information. Maintains current information on governmental regulation changes and updates affecting coding, staffing and reimbursement.
Supervisory Responsibilities:
Perform management responsibilities including but not limited to involvement in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct, and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
Job Requirements:
Experience:
Required: 5+ years of experience in risk adjustment, Medicare Advantage operations, and managing CMS or other regulatory audits.
Preferred: 3+ years of experience in a leadership role and health plan medical coding processes and procedures
Education:
Required: Bachelor's degree in a relevant field
Preferred: Professional certifications such as Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC) or Certified Coding Specialist (CCS) are highly desirable.
Specialized Skills:
Required: Deep knowledge of the CMS-HCC Risk Adjustment model, ICD-10 coding guidelines, and the end-to-end RADV process is essential. Familiarity with Medicare regulations and compliance requirements is also critical. Strong leadership, communication, and project management skills are required to oversee complex, time-sensitive audits.
Pay Range: $149,882.00 - $224,823.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries 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 at ******************************* If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email ******************.
$149.9k-224.8k yearly Auto-Apply 60d+ ago
Business Analyst
Alignment Healthcare 4.7
Alignment Healthcare job in Orange, CA
Business Analyst
External Description:
Business Analyst
Alignment Healthcare seeks a motivated Business Analyst to support the implementation and development of its proactive member outreach and engagement programs. The ideal candidate will not only have the skills to meet the job responsibilities, but a genuine passion and understanding for how an innovative customer service approach can anticipate our members' needs and make the difference in their healthcare experience. This position will be a valued partner to our executive leadership.
Essential Duties and Responsibilities:
Essential duties and responsibilities of the Business Analyst include, but are not limited to:
Review, analyze, and evaluate systems and user needs
Document requirements, define scope and objectives, and formulate systems
Construct workflow charts and diagrams; study system capabilities; write specifications
Improve systems by studying current practice and designing modifications; understand and communicate the financial and operational impact of any changes; actively participate in the implementation of approved changes
Recommend controls by identifying problems and improving or establishing new policies and standard operating procedures
Define project requirements by identifying project milestones, phases, and elements; form project team; establish project budget
Monitor project progress by tracking activity; resolve problems; publish progress reports; recommend actions
Maintain user confidence and protect operations by keeping information confidential
Prepare technical reports by collecting, analyzing, and summarizing information and trends
Contribute to team effort by accomplishing related results as needed
Validate resource requirements and develop cost estimate models
Create informative, actionable, and repeatable reporting that highlights relevant business trends and opportunities for improvement
Maintain positive relationships within and between operational departments by coordinating information exchange, keeping stakeholders informed of progress and risks, and maintaining detailed and organized documentation
Minimum Requirements:
Minimum Experience:
Background in health care provider and/or health plan settings, preferably with experience in IT system implementations, provider relations, IPA, revenue cycle management, and/or vendor management.
Intermediate to Advanced understanding of project management with a minimum of 3 years of work experience in project management.
Intermediate to Advanced proficiency required in MS Office products including Word, Excel, PowerPoint, Visio and MS Project.
Education/Licensure:
Bachelor's Degree in appropriate field of study or equivalent work experience
Other:
Intermediate or Advanced proficiency in MS Office products including Word, Excel, PowerPoint, Visio, and MS Project
Skills in Microsoft Access and/or SQL, Power BI, or other data tools strongly preferred
High-energy: ability to impact operations and affect change
Detail oriented, analytical, and inquisitive
Ability to work independently and with others
Communication skills to bridge people, process, and technology
Extremely organized with strong time-management skills
Excellent presentation and training skills
Motivated to learn and operate with flexibility
Ability to prioritize multiple and competing tasks
Ability to work well in a fast-paced and dynamic environment
Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.
If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact ******************.
City: Orange
State: California
Location City: Orange
Schedule: Full Time
Location State: California
Community / Marketing Title: Business Analyst
Company Profile:
Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.
By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.
EEO Employer Verbiage:
On August 17, 2021, Alignment implemented a policy requiring all new hires to receive the COVID-19 vaccine. Proof of vaccination will be required as a condition of employment subject to applicable laws concerning exemptions/accommodations. This policy is part of Alignment's ongoing efforts to ensure the safety and well-being of our staff and community, and to support public health efforts. Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran. If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact ******************.
$93k-123k yearly est. Easy Apply 60d+ ago
Coordination of Benefits Representative
Alignment Healthcare 4.7
Alignment Healthcare job in Orange, CA
Coordination of Benefit Representative
External Description:
The Membership & Eligibility Representative is responsible for the daily operations of both Eligibility and Membership Department. Provides Alignment Health Plan (AHP) internal departments, employee/partners and contracted providers in obtaining proper eligibility and membership data.
Essential Duties and Responsibilities
Essential duties and responsibilities include but are not limited to:
Responsible for the reconciliation of all lines of business, as well as the CMS monthly files.
Responsible to assist within both areas of membership and eligibility. This includes late enrollment penalty, disenrollments, out of areas, retros, third party submissions etc.
Updating and deleting members other coverage through COB contractor via ECRS.
Ensure members file is flagged with the proper coverage. (primary or secondary)
Ensure all COB data is transferred into EZ-Cap.
Responsible for surveying current members with other coverage on a yearly basis as well as new members.
Collaborate with I.T. on creating reports and any system updates as per CMS guidelines.
Responsible for meeting the regulatory compliance in all areas that affect the Eligibility and Membership.
Answers the incoming phone calls within the goal marks set. Responsible for the daily, weekly, and monthly review and reporting of departmental queue stat reports to include Wrap-Up Code Reports, Resolution Contact Reports, and Agent Availability Reports.
Ongoing clean-up of member data in all lines of business to ensure correct member information is provided to all systems and vendors.
Meet specific deadlines. Responds to variations in daily workload by assigning task priorities according to department policies and standards.
Ensure daily TRR is validated and all transactions are reviewed.
Problem-solving process to resolve and/or mitigate those operational issues resulting in negative performance to plan as determined by the established escalation process.
Will ensure that participation is made in the development and implementation of programs with direct effect towards the eligibility department. Participate in training programs and with the creation of materials for the day-to-day activity that is performed within the department.
Will assist with creating department policies and procedures as needed to ensure the department is in accordance with CMS guidelines.
Ensure all files are maintained in the shared drive.
Submit monthly productivity reports to the Director.
Assists with creating and implementing systems to improve workflows, tracking, reporting, and maintenance.
Performs other duties as assigned.
Supervisory Responsibilities
There are no supervisory responsibilities.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
High school diploma required; BA preferred
Minimum 2-5 years in a Health Maintenance Organization HMO or Medicare Advantage Prescription Drug Plan( MA-PD) preferred
Must be familiar with CMS MMR and TRR files
Chapter 2 Manage Care
Strong sense of excellent customer service
Strong written communication skills
Proficient data entry skills
Proficiency with Microsoft Office (Word, Excel, Access)
Ability to complete tasks in a timely manner
Strong organizational skills
Ability to communicate effectively
Good organizational skills
Ability to prioritize
Self-starter and able to work independently
Excellent problem solving skills
Skills and Abilities
Language Skills:
Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.
Mathematical Skills:
Ability to add and subtract two digit numbers and to multiply and divide with 10's and 100's. Ability to perform these operations using units of American money and weight measurement, volume, and distance.
Reasoning Skills:
Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
Computer Skills:
Strong computer skills.
Other Skills and Abilities:
Strong organizational skills.
Good telecommunications skills.
Attention to detail a must.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
The employee is frequently required to walk; stand; reach with hands and arms.
The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.
The employee must occasionally lift and/or move up to 20 pounds.
Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
Working Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
City: Orange
State: California
Location City: Orange
Schedule: Full Time
Location State: California
Community / Marketing Title: Coordination of Benefits Representative
Company Profile:
Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.
By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.
EEO Employer Verbiage:
On August 17, 2021, Alignment implemented a policy requiring all new hires to receive the COVID-19 vaccine. Proof of vaccination will be required as a condition of employment subject to applicable laws concerning exemptions/accommodations. This policy is part of Alignment's ongoing efforts to ensure the safety and well-being of our staff and community, and to support public health efforts. Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran. If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact ******************.
$40k-50k yearly est. Easy Apply 60d+ ago
Member Experience Support Clerk
Alignment Healthcare 4.7
Alignment Healthcare job in Orange, CA
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
The Member Experience Support Clerk is responsible for providing daily clerical support to the Member Ser-vices Department including but not limited to; the Member Services Representatives, Transportation Unit, Member Outreach Unit, and Appeals and Grievances Team.
Job Duties/Responsibilities:
Tracks incoming member correspondence in the department mail log & EZ Member database.
Assigns a MS Representative as appropriate for follow up including “Request for Assistance” forms from the Sales/Marketing Dept daily.
Tracks the incoming Health Risk Assessment Surveys into the EZ Member database and logs all HRA Vitamin Coupons.
Maintains the departments miscellaneous filing in an organized fashion and create files for new staff as needed.
Maintains the inventory of department supplies (ID Card Stock, PCP Change Forms, ID Card Holders, Birthday Cards, Transportation Postcard Reminders, etc.,) and orders supplies as needed.
Maintains daily, monthly department mailings including but not limited to, birthday cards, anniversary cards, condolence cards, and miscellaneous mailings.
Acknowledges and logs the receipt of all grievances, appeals, and CTM (Complaint Tracking Module). Provides clerical support to the Appeals and Grievance Coordinator.
Assembles, maintains & protects member A&G case files in an organized fashion.
Faxes grievance response requests to appropriate parties for the gathering of all pertinent and relevant information from the provider regarding the grievance/appeal.
Provides follow up calls to providers and/or IPA and members as appropriate to ensure compliance with timelines set forth to ensure CMS compliance.
Logs point of contacts of providers and/or IPA and members.
Performs other duties clerical or otherwise as assigned by the Department Manager.
Supervisory Requirements:
None.
Job Requirements:
Experience:
• Required: Minimum 1 month of related experience and/or training; or equivalent combination of education and experience.
• Preferred: None.
Education:
• Required: High School Diploma or GED.
• Preferred: None.
Training:
• Required: None.
• Preferred: None.
Specialized Skills:
• Required:
Knowledge of Medi-Cal, Commercial, and Medicare Managed Care Plans.
Bilingual (English/Spanish) required.
Basic Computer Skills, 30 WPM (Microsoft Outlook, excel, word).
10-Key by Touch.
Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors.
Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly.
Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
Licensure:
• Required: None.
• Preferred: None.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $41,600.00 - $57,600.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries 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 at ******************************* If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email ******************.
$41.6k-57.6k yearly Auto-Apply 1d ago
Data Scientist
Alignment Healthcare 4.7
Alignment Healthcare job in Orange, CA
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
Alignment Healthcare is a data and technology driven healthcare company focused partnering with health systems, health plans and provider groups to provide care delivery that is preventive, convenient, coordinated, and that results in improved clinical outcomes for seniors.
We are seeking a mission-driven Data Scientist to join our growing team and support risk adjustment strategy within our Medicare Advantage line of business. This role focuses on enhancing risk score accuracy, CMS audit preparedness (RADV), and building AI-powered tools that improve clinical documentation review and integrity.
You'll play a key role in advancing AVA, our proprietary clinical intelligence platform, by developing next-generation models that support autonomous chart review and NLP/GenAI-driven documentation analytics. This is a unique opportunity to work at the intersection of healthcare, compliance, and machine learning-transforming how we ensure both quality and regulatory alignment.
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
Alignment Healthcare is a data and technology driven healthcare company focused partnering with health systems, health plans and provider groups to provide care delivery that is preventive, convenient, coordinated, and that results in improved clinical outcomes for seniors.
We are seeking a mission-driven Data Scientist to join our growing team and help develop predictive models and intelligent workflows that drive better member health outcomes, improve quality metrics, and enhance operational efficiency across our Medicare Advantage offerings. You'll work on a diverse portfolio of high-impact projects spanning clinical intelligence, quality improvement, payment integrity, and emerging AI/NLP solutions, all underpinned by our proprietary AVA technology platform.
This is a unique opportunity to work at the intersection of healthcare, machine learning, and real-world impact, applying advanced analytics to solve complex problems that improve the quality of healthcare for our members.
Job Duties/Responsibilities
Collaborate with business stakeholders to understand complex healthcare and operational challenges, then design and implement analytical solutions that drive measurable outcomes
Develop predictive models and workflows for AVA, our proprietary clinical intelligence platform, supporting autonomous chart review, clinical analytics, disease detection, and compliance forecasting
Build and deploy scalable model pipelines that integrate NLP, random forests, gradient boosted algorithms, ensemble models, and data processing using Python, R, Databricks, MLFlow, and Unity Catalog
Design and implement quality improvement models in partnership with our Quality team to enhance member health outcomes, improve Stars ratings, and support HEDIS reporting and forecasting initiatives
Develop automated validation and quality assurance models for the Payment Integrity team to improve accuracy and reduce manual review burden
Build AI / NLP / LLM solutions for document understanding, including the training of vision detection algos and development / deployment of OCR and NER pipelines that process medical charts at scale
Collaborate with engineering teams to version, test, and deploy models using Git, CI/CD pipelines, GitHub, Azure, and cloud-based infrastructure
Design algorithms to predict audit risk and detect documentation anomalies across cohorts and markets, supporting RADV audit preparedness and CMS compliance
Partner cross-functionally with Pharmacy, Actuaries, Clinical, Data Engineering, and Software Engineering teams to ensure analytical outputs align with CMS guidance and regulatory requirements
Support CMS Star Ratings strategy, including HEDIS, CAHPS, and HOS analysis and predictive modeling, and root cause analysis on rate movement through the measurement year
Help standardize definitions, documentation logic, and reporting workflows at scale for enterprise-wide AI readiness and analytical capabilities
Supervisory Responsibilities: N/A
MINIMUM REQUIREMENTS:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Minimum Experience:
2+ years of relevant experience in predictive modeling, machine learning, and data science
Demonstrated ability to build end-to-end data science solutions with measurable real-world impact
Education/Licensure:
Preferred: MSc or PhD in Computer Science, Engineering, Mathematics, Statistics, or related field, OR equivalent professional experience
Other:
Strong programming proficiency in Python and/or R (primary focus for this role)
Solid understanding of data structures, algorithms, and software engineering principles
Demonstrated proficiency in SQL and relational databases
Experience with Git and version control workflows
Deep knowledge of machine learning algorithms, including deep neural networks, NLP, and LLMs
Experience manipulating and analyzing complex, high-volume, high-dimensionality, and unstructured data from multiple sources
Expertise in experimental design, statistical rigor (confidence intervals, significance testing, train/test/validation methodology)
Strong data visualization and presentation skills; ability to translate complex analysis into actionable insights
Excellent communication and collaborative problem-solving abilities
Demonstrated ability to thrive in ambiguous, fast-paced environments while prioritizing effectively
Strong analytical mindset with attention to detail and commitment to data quality
Preferred Qualifications:
Healthcare industry experience or familiarity with healthcare data challenges
Hands-on experience with Databricks for distributed data processing and ML workflows
Experience with MLFlow and Unity Catalog for model versioning and governance
Experience with Azure, AWS, or other cloud ecosystems
Familiarity with NoSQL databases
Knowledge of CMS and Medicare Advantage operations
Published work in academic conferences or industry circles
Experience with containerized environments and CI/CD pipelines
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
ESSENTIAL PHYSICAL FUNCTIONS:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $149,882.00 - $224,823.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries 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 at ******************************* If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email ******************.
$149.9k-224.8k yearly Auto-Apply 60d+ ago
Virtual Concierge Navigator, Medical Assistant
Alignment Healthcare 4.7
Alignment Healthcare job in Orange, CA
Virtual Concierge Navigator, Medical Asst.
External Description:
Virtual Concierge Navigator, Medical Assistant
The ACCESS On-Demand Concierge is Alignment Healthcare's model to ensure best-in-class service and care coordination 24/7. As a member of this team, you will be at the center of our member experience and the face of Alignment Healthcare. You will provide members with “White Glove” service and act as a guide to help our members navigate their virtual experience and health care overall.
The Virtual Concierge Navigator ensures member satisfaction and customer service are provided at the level of excellence that our members deserve. To do so, you will become an expert on our health plan and supplemental benefits, care deliver model, and provider network; you will also serve as the liaison among members, providers, and internal departments. By ensuring an “aligned” experience is available to our members at any time of day or night, over the phone, through video-chat, and messaging.
Essential Duties and Responsibilities:
Essential duties and responsibilities of the Virtual Concierge Navigator include, but are not limited to:
• Be knowledgeable in procedures, protocols, benefits, services, and any other necessary information to resolve member issues and inquiries; serve as a “subject matter expert” in the health care experience that our members navigate daily.
• Resolve incoming calls concerning members' eligibility, benefits, provider information, clinical, and pharmacy needs; coordinate membership changes such as member's primary care physician and proactively engage member with their wellness plan options.
• Collaborate with our partners - including but not limited to other departments, supplemental benefit vendors, and provider network - to facilitate the member experience.
• Responsible for receiving inbound phone calls within the department's goal timeframe; may be required to communicate with members in other channels including e-mail, web chat, SMS/text, as required.
• Manage to the member's communication preferences as possible, which may include time of day, channel, and language; utilize interpreter service as needed.
• Responsible for real-time documentation (i.e., caller name, contact info, call reason, action taken, resolution, etc.) and timely wrap-up to support outcomes reporting, in all systems/applications as required.
• Provide administrative support to virtual providers with referrals and initiating authorization requests as deemed appropriate, following up to ensure completion.
• Coordinates member's care for PCP care plan, diagnostic tests, radiology, laboratory, and specialty appointments. Ensures appointments are scheduled and confirmed with the member via Alignment's EMR system; confirms demographics entered are complete. Schedules transportation as appropriate.
• Manage appropriate clinical escalations and triage; link the member to appropriate clinical resources.
• Verify the member is included in or targeted for any outreach or care gap programs and connect members to programs (such as chronic disease programs) or services when appropriate. Analyze available programs, determine program eligibility, and assists with enrollment of such program as appropriate.
• Monitor communication channels as assigned and manage replies to ensure all metrics for timeliness and member experience success are met.
• Develop, write, and edit digital replies, which may involve coordination of health plan benefits knowledge, reference documents, member resources, insights from key stakeholders, and more to be determined.
• Follow communication “scripts” and/or templates as appropriate, ensuring the consumers' needs are clearly understood and resolved.
• Excel in customer service and contribute to a culture of going “above and beyond” to ensure the highest level of member satisfaction.
• Adhere to all applicable attendance policies to ensure consistent and reliable queue coverage, which is essential to the member experience.
Supervisory Responsibilities
This job has no supervisory responsibilities.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Education and/or Experience: High school diploma or general education degree (GED).
2. Certificates, Licenses, Registrations: Medical Assistant Certification. Required.
3. Other Qualifications:
• Medical front/back office experience.
• Knowledge of ICD-10 and CPT codes.
• High-volume inbound customer service experience, particularly for health plan or Medicare “Member Services” roles in health plan and supplemental benefits. Preferred.
• Telemarketing and/or member outreach experience. Preferred.
• Specialized experience in escalation or resolution units. Preferred.
Skills and Abilities
1. Communication Skills: Strong communication skills via email and phone. Fluency in written and verbal Spanish, Korean, or Vietnamese, a plus.
2. Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.
3. Mathematical Skills: Ability to add and subtract two digit numbers and to multiply and divide with 10's and 100's. Ability to perform these operations using units of American money and weight measurement, volume, and distance.
4. Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
5. Computer Skills: Strong computer skills.
6. Other Skills and Abilities:
a. Computer literate, typing 40+ words per minute.
b. Excellent communication skills, oral and written.
c. Must pass a writing test. Impeccable grammar and spelling.
Please note: No time off granted during Onboarding/Training and for Jan 1 - Jan 30, 2021 due to high call volume for calendar year enrollment. Must be willing to work overnight, weekends, and holidays as scheduled.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
2. The employee is frequently required to walk; stand; reach with hands and arms.
3. The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.
4. The employee must occasionally lift and/or move up to 20 pounds.
5. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
Working Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. The noise level in the work environment is usually moderate.
2. Remote, work from home positions available.
City: Orange
State: California
Location City: Orange
Schedule: Full Time
Location State: California
Community / Marketing Title: Virtual Concierge Navigator, Medical Assistant
Company Profile:
Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.
By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.
EEO Employer Verbiage:
On August 17, 2021, Alignment implemented a policy requiring all new hires to receive the COVID-19 vaccine. Proof of vaccination will be required as a condition of employment subject to applicable laws concerning exemptions/accommodations. This policy is part of Alignment's ongoing efforts to ensure the safety and well-being of our staff and community, and to support public health efforts. Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran. If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact ******************.
$37k-44k yearly est. Easy Apply 60d+ ago
Appeals & Grievance Coordinator (Temporary)
Alignment Healthcare 4.7
Alignment Healthcare job in Orange, CA
Appeals & Grievance Coordinator
External Description:
Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.
By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.
Summary
The Appeals & Grievance Coordinator is responsible for the day to day functions of the tracking and trending of all grievances, appeals, and complaints received within the Member Services Department. The coordinator will act as the primary investigator and contact person for member and provider grievances and appeals.
Essential Duties and Responsibilities
(May include but are not limited to:)
Will appropriately acknowledge the receipt of all grievance/appeals, and CTM (Complaint Tracking Module).
Responsible for the gathering of all pertinent and relevant information from the member and/or provider regarding the grievance/appeal, determining the appropriate resolution of the grievance/appeal per standard policies and procedures; and notifying the appropriate parties of the resolution and ensuring that all internal processes are completed to resolve the issue.
Compose written correspondence to members in accordance to plan policy and CMS Guidelines.
Conduct non-biased, accurate, timely and comprehensive investigation of all the facts related to the grievance/appeal.
Thoroughly document all action taken on behalf of the member or provider to resolve the grievance/appeal.
Ensure that all grievances/appeals are processed in adherence to the Centers for Medicare and Medicaid (CMS) guidelines and plan policy.
Prepare case files for Medical Director review and external (including IRE) review of grievances/appeals as appropriate.
Prepare clear, objective, accurate and comprehensive case histories for presentation and consideration at committee meetings (including Board of Directors).
Maintain accurate and timely documentation, including complete files of all grievances/appeals. Prepare monthly and quarterly reports as requested.
Identify training opportunities and potential system and process improvements relating to grievance/appeal data.
Participate in periodic review and update of grievance/appeal policies and procedures to reflect appropriate legal and CMS requirements as well as participate in periodic CMS Audit preparations and regulator meetings/interviews.
Maintain a positive and professional relationship with plan staff, providers, members, and regulators.
Other duties as assigned.
Supervisory Responsibilities
None.
Minimum Requirements
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience: High school diploma or general education degree (GED)
Certificates, Licenses, Registrations: None required.
Other Qualifications:
Knowledge of Medi-Cal or Medicare Managed Care Plans.
Three to five years customer service experience.
Two to three years of Appeals & Grievance preferred.
Bi-lingual (English/Spanish) preferred.
Skills and Abilities
Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.
Mathematical Skills: Ability to add and subtract two-digit numbers and to multiply and divide with 10's and 100's. Ability to perform these operations using units of American money and weight measurement, volume, and distance.
Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
Computer Skills: Strong computer skills.
Other Skills and Abilities:
Excellent communication skills.
Excellent written skills
Good telephone techniques.
Excellent data entry.
Strong organizational skills.
Type 40+ words per minute.
Experience with 10-key by touch.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
The employee is frequently required to walk; stand; reach with hands and arms.
The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.
The employee must occasionally lift and/or move up to 20 pounds.
Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
Working Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually moderate.
City: Orange
State: California
Location City: Orange
Schedule: Full Time
Location State: California
Community / Marketing Title: Appeals & Grievance Coordinator (Temporary)
Company Profile:
Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.
By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.
EEO Employer Verbiage:
On August 17, 2021, Alignment implemented a policy requiring all new hires to receive the COVID-19 vaccine. Proof of vaccination will be required as a condition of employment subject to applicable laws concerning exemptions/accommodations. This policy is part of Alignment's ongoing efforts to ensure the safety and well-being of our staff and community, and to support public health efforts. Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran. If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact ******************.
$45k-59k yearly est. Easy Apply 60d+ ago
Manager, Utilization Management (Coordination)
Alignment Healthcare 4.7
Alignment Healthcare job in Orange, CA
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
The Manager, Utilization Management (UM) Coordination, oversees non-clinical inpatient and pre-service operations under the direction of the Director of Utilization Management. This role provides leadership to UM Supervisors and their coordinator teams to ensure timely, accurate, and compliant processing of authorizations and referrals in accordance with CMS and organizational standards. The Manager drives operational efficiency, staff development, and process improvement while collaborating with internal departments to support continuity of care and overall service quality.
Job Responsibilities:
Provide operational leadership and direction to two Utilization Management Supervisors overseeing non-clinical coordinator teams supporting both Inpatient and Pre-Service workflows.
Lead the teams meet established turnaround times (TATs), quality, and productivity standards for authorization processing, referral routing, and related UM functions.
Oversee staffing allocation, scheduling, and workload balancing between inpatient and pre-service units to maintain consistent service levels.
Conduct regular one-on-one meetings with supervisors to review performance metrics, workflow barriers, and staff development needs.
Own the daily operations to ensure timely and accurate completion of authorizations, correspondence, and documentation in compliance with CMS, NCQA, and organizational standards.
Identify process inefficiencies and implement corrective actions to improve turnaround, accuracy, and staff productivity.
Lead root-cause analyses for escalated operational issues and coordinate corrective action plans.
Responsible for all the accuracy of all UM workflows, systems, and reporting dashboards to support data-driven decision making.
Oversee the development and delivery of training materials, competency assessments, and reference guides to promote consistent and compliant practices.
Mentor Supervisors to build leadership capacity, coaching them on staff management, delegation, and performance improvement techniques.
Drive onboarding, cross-training, and refresher sessions are regularly conducted to support staff versatility across inpatient and pre-service functions.
Manage all team activities adhere to CMS and organizational policies related to Utilization Management, confidentiality, and member communication standards.
Oversee internal audit reviews and collaborate with the Quality and Compliance teams to address findings and implement improvement plans.
Direct that all letters and communications use approved templates and standardized language for UM determinations and continuity-of-care requirements.
Participate in internal and external audits, Medical Services Committee meetings, and other regulatory reviews as required.
Review and analyze key performance indicators (KPIs), including volume, turnaround time, accuracy, and productivity reports; present trends and improvement strategies to leadership.
Support the preparation and submission of monthly UM reports, dashboard summaries, and Medical Services Committee deliverables.
Leverage data to identify training needs, process gaps, and operational trends impacting service delivery or compliance.
Serve as a liaison between UM, Case Management, Provider Relations, and Claims departments to streamline interdepartmental communication and issue resolution.
Collaborate with network providers and internal teams to clarify authorization processes and ensure alignment with benefit and policy criteria.
Participate in internal workgroups or initiatives to improve system functionality, workflow automation, and reporting enhancements.
Assist with the development, implementation, and monitoring of UM-related initiatives and special projects (e.g., claims review process, continuity-of-care tracking, or performance optimization programs).
Evaluate and revise UM policies and procedures to align with evolving regulatory standards and organizational goals.
Support readiness activities for CMS audits and other accreditation requirements.
Perform other related functions and special assignments as directed by senior leadership.
Core Competencies:
Leadership & Talent Development - Demonstrates the ability to lead through others by developing and empowering supervisors and staff. Fosters a culture of accountability, engagement, and continuous improvement within the UM department.
Operational Management - Applies strong organizational and analytical skills to oversee workflow execution, resource allocation, and performance metrics across inpatient and pre-service teams.
Regulatory & Compliance Expertise - Maintains in-depth knowledge of CMS regulatory standards, confidentiality requirements, and UM protocols to ensure full compliance and audit readiness.
Analytical Thinking & Decision-Making - Uses data to identify trends, evaluate outcomes, and implement process improvements that enhance accuracy, turnaround times, and service quality.
Communication & Collaboration - Communicates clearly across all organizational levels; partners effectively with Clinical Operations, Provider Relations, Case Management, and Claims to resolve issues and align priorities.
Process Improvement & Innovation - Continuously evaluates operational workflows and implements efficiency strategies that support organizational goals and member satisfaction.
Member & Service Orientation - Demonstrates commitment to delivering high-quality service, ensuring that UM processes support positive member experiences and continuity of care.
Change Management - Adapts to evolving regulatory, system, and organizational needs while leading teams through process transitions and new initiatives effectively.
Supervisory Responsibilities:
Oversees assigned staff. Responsibilities include: recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and performance management.
Job Requirements:
Experience
Required: Minimum (4) years of related experience in a managed care setting and a minimum (3) years of recent and related supervisory experience
Education
Required: Highschool Diploma or GED Required
Preferred: Bachelor's Degree or higher
Other:
Strong knowledge of Medicare Managed Care Plans
Proficient in Microsoft Word, Excel, and Outlook; advanced Excel skills preferred (pivot tables, formulas, data visualization, and reporting functions for performance tracking and analysis).
Experience leading and sustaining process improvement initiatives within healthcare operations to enhance efficiency, compliance, and service quality.
Communication and Interpersonal Skills - Excellent written and verbal communication skills; able to build and maintain collaborative relationships with diverse teams, including leadership, staff, and external partners.
Analytical and Reasoning Skills - Strong analytical thinking with the ability to define problems, collect and interpret data, establish facts, draw valid conclusions, and develop actionable solutions.
Problem-Solving and Organizational Skills - Demonstrated ability to prioritize multiple tasks, manage time effectively, and maintain accuracy in a fast-paced, dynamic environment.
Data and Report Analysis - Ability to interpret, analyze, and present statistical and operational reports to support decision-making and performance monitoring.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $70,823.00 - $106,234.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries 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 at ******************************* If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email ******************.
$70.8k-106.2k yearly Auto-Apply 45d ago
Nurse Practitioner/Physician Assistant - Must be willing to do Home Visits in the Inland Empire Area
Alignment Healthcare 4.7
Alignment Healthcare job in San Bernardino, CA
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
The NP or PA will be apart of the Care Anywhere (CAW) program is designed to provide care and support to our Alignment Healthcare patients by providing an additional level of medical and social support in the comfort of their own home. This program is offered to eligible patients at no cost to them with the goal of preventing unnecessary hospitalizations, health complications, and unmanaged disease progression that can occur when timely clinical interventions are not provided or are not accessible.
Here are some of the benefits that you will enjoy:
• Yearly Bonus up to 7.5% of annual base salary
• Restricted Stock Unit (RSU) Grant up to 15% of annual salary
• Continuing education reimbursement up to $1,500 per calendar year + 3 CME days
• 18 days of PTO, 8 paid holidays and 1 Floating Holiday
• Medical, Dental, Vision
• 401k matching contribution up to 4%
• Paid parental leave
• Tuition reimbursement
Responsibilities: This is a M-F position with traditional work hours doing home visits 4 days a week in the Inland Empire Area and working remotely 1 day a week.
1. Conduct in-home assessments on Alignment members, medication review and health screenings
2. Provide patient education by matching care desired with best care given
3. Identify diagnoses to be assessed in care management and active medical management
4. Partner and communicate with Regional Medical Officer and other team members to discuss and develop the most appropriate care plans possible based on the needs of our members/patients.
5. Coordinate care with multiple stakeholders, including but not limited to PCPs, specialists, and ancillary providers.
6. Lead broader clinical team which may include nurses, health coaches, social workers, and care coordinators
Job Requirements:
Experience:
• Preferred: One (1) year of prior clinical or home care experience. Previous EMR experience preferred. Experience in care of older adult (geriatric) patients preferred
Education:
• Required: Master's degree from an accredited NP Program or PA program
Licensure:
• Required: Active Nurse Practitioner or Physician Assistant license
Active License and Furnishing number (Must, upon hire) NP only
Active Nurse Practitioner Board Certification/Physician Assistant Certification
NPI Number, DEA, Valid BLS
Valid Driver License and current automobile insurance
• Preferred:
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 20 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $130,332.00 - $195,498.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries 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 at ******************************* If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email ******************.
$130.3k-195.5k yearly Auto-Apply 60d+ ago
Scheduling Specialist
Alignment Healthcare 4.7
Alignment Healthcare job in Orange, CA
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
The Scheduling Specialist provides outreach and support to ensure all our eligible members have access to the care they deserve around our available Clinical/Patient Programs. Assists in navigating our members through the different programs they may be eligible and assists in scheduling them for what best suits their needs. Navigates with our members every step of the way to ensure they are never alone in their healthcare journey. Utilizes excellent customer service measures and understand the meaningful contribution the team makes to our members' healthcare outcomes.
Job Duties/Responsibilities:
1. Serves as a “subject matter expert” in the clinical programs that our members may be eligible for. This includes being knowledgeable in procedures, scheduling for Health Assessments, protocols, benefits, services, and any other necessary information to resolve member issues and inquiries.
2. Conducts member outreach phone calls and/or receiving inbound phone calls within the department's goal timeframe; manage to the member's communication preferences as possible, which may include time of day, channel, and language; utilize interpreter service as needed.
3. Collaborates with our partners - including but not limited to other departments, Member Services, and Clinical Departments - to facilitate the member experience.
4. Identifies members targeted for care gaps and other campaigns, and connect members to programs or services when appropriate; analyze available programs, determine program eligibility, and connect member to appropriate provider or vendor
5. Responsible for real-time documentation and timely wrap-up to support outcomes reporting in all systems/applications as required; must enter member demographics and information with accuracy and attention to detail, i.e. feel responsibility for the quality of our organizational data
6. Responsible for meeting or exceeding individual and team goals, and for submitting activity reports in the format and frequency required
7. Excels in customer service and contributes to a culture of going “above and beyond” to ensure the highest level of member satisfaction.
8. Other duties as assigned.
Job Requirements:
Experience:
• Required: Minimum 1 year of call center experience helping members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations.
• Preferred: Experience in Clinical setting in managing provider schedules. Experience helping members navigate their Medicare Advantage benefits including medical, prescription drug, and supplemental benefits. Call Center experience in welcome/onboarding, appointment scheduling, retention, sales, or other health care/health plan related programs; and/or inbound call center experience that indicates a higher level of problem-solving such as escalation or resolution
Education:
• Required: High School Diploma or GED.
• Preferred: College courses
Training:
• Required:
• Preferred:
Specialized Skills:
• Required:
Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.
Mathematical Skills: Ability to add and subtract two-digit numbers and to multiply and divide with 10's and 100's. Ability to perform these operations using units of American money and weight measurement, volume, and distance.
Reasoning Skills: Ability to apply common sense understanding to carry out detailed, but un-involved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
Computer Skills: Strong computer skills. typing 40+ words per minute.
Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
• Preferred: Bilingual English/Spanish, or Vietnamese, Chinese (Mandarin), Korean
Licensure:
• Required: None
Other:
• Required: Must be available to work full-time and over-time through the Annual Enrollment Period (Oct-Dec) and Open Enrollment Period (Jan-Mar)
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $41,600.00 - $57,600.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries 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 at ******************************* If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email ******************.
$41.6k-57.6k yearly Auto-Apply 1d ago
Manager, Member Engagement
Alignment Healthcare 4.7
Alignment Healthcare job in Orange, CA
Manager, Member Engagement
External Description:
Manager, Member Engagement
This management position will oversee our outreach teams that are dedicated to proactive member engagement. The Manager, Member Engagement is at the helm of our outbound contact center strategy and operations. As you drive process improvement and team performance, we will build an exceptional service-oriented culture that anticipates our members' needs.
Essential Duties and Responsibilities:
Essential duties and responsibilities of the Manager, Member Engagement include, but are not limited to:
Partner with executive leadership to determine and understand contact center operational strategy by conducting needs assessments, performance reviews, capacity planning, workforce management, and cost/benefit analysis
Conduct candidate interviews, make hiring decisions, and oversee successful new employee onboarding
Monitor the activities and productivity of all staff in office and remote (work from home) locations; ensure quality assurance; deliver related reporting to executive leadership as required
Evaluate the performance of direct reports, and provide coaching, counsel, performance improvement plans, etc. in regular performance review meetings
Champion team engagement and create a culture of service excellence, positivity, and teamwork
Create, implement, and test new workflows and processes
Coordinate work activities with other leadership and departments to streamline the member experience and identify efficiencies for the business
Serve as a team representative in meetings and audits as required
Lead by example: demonstrate reliability and accountability in attendance and the quality of your work product; ensure a culture of professionalism and discipline
Other assignment and projects as assigned
Minimum Requirements
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Minimum Experience: five (5) years of Call Center experience including at least three (3) years in a management capacity in a compliance-driven industry; previous health plan and/or Medicare Advantage experience preferred
Education and/or Experience: Bachelor's degree, or equivalent experience
Certificates, Licenses, Registrations: None required
Other Qualifications - preferred, but not required:
Proven track record to monitor and motivate employees; experience that includes oversight of remote workforce and/or vendor a plus
Demonstrated success with implementation and/or management of applications including workforce management, CRM, campaign manager, EMR PM, etc.
Excellent communication skills, both written and verbal; bilingual English/Spanish preferred
Strong interpersonal skills and a collaborative management style
Attention to detail, with sound critical thinking and follow up skills
Ability to manage multiple priorities simultaneously with timelines and short turn-around times
Advanced computer skills (Outlook, Excel, PowerPoint, Word) required
Genuine passion and goals for career-level customer service
City: Orange
State: California
Location City: Orange
Schedule: Full Time
Location State: California
Community / Marketing Title: Manager, Member Engagement
Company Profile:
Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.
By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.
EEO Employer Verbiage:
On August 17, 2021, Alignment implemented a policy requiring all new hires to receive the COVID-19 vaccine. Proof of vaccination will be required as a condition of employment subject to applicable laws concerning exemptions/accommodations. This policy is part of Alignment's ongoing efforts to ensure the safety and well-being of our staff and community, and to support public health efforts. Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran. If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact ******************.
$101k-126k yearly est. Easy Apply 60d+ ago
Accounting Coordinator
Alignment Healthcare 4.7
Alignment Healthcare job in Anaheim, CA
Accounting Coordinator
External Description:
Testing
City: Anaheim
State: California
Schedule: Full Time
Community / Marketing Title: Accounting Coordinator
Company Profile:
Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.
By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.
EEO Employer Verbiage:
On August 17, 2021, Alignment implemented a policy requiring all new hires to receive the COVID-19 vaccine. Proof of vaccination will be required as a condition of employment subject to applicable laws concerning exemptions/accommodations. This policy is part of Alignment's ongoing efforts to ensure the safety and well-being of our staff and community, and to support public health efforts. Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran. If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact ******************.
$43k-56k yearly est. Easy Apply 60d+ ago
Bilingual Spanish Social Worker (Home visits in West / Downtown Los Angeles)
Alignment Healthcare 4.7
Alignment Healthcare job in Los Angeles, CA
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
Alignment health is seeking a bilingual Spanish social worker (Masters of Social Work required) to join the interdisciplinary Care Anywhere team in West / Downtown Los Angeles, California. The Social Worker assess' and evaluates members' needs and requirements to achieve and/or maintain their health. Guides members and their families toward and facilitate interaction with resources appropriate for their care and well-being. Works in collaboration with a multi-disciplinary teams, employing a variety of strategies, approaches and techniques to enable a member to manage their physical, environmental and psycho-social health issues.
Schedule:
- Monday - Friday, 8:00 AM - 5:00 PM Pacific Time (Required)
- (4) Home visits per day (mileage reimbursement provided.)
GENERAL DUTIES/RESPONSIBILITIES
1. Conducts telephonic outreach to assigned members to assess health, environment, nutrition, and psycho-social areas of concerns using a variety of assessments.
a. In response to assessments, coaches and problem solves with member to identify and address specific goal(s) to support health and behavior change.
b. Provides appropriate interventions to optimize health and well-being. Interventions may include education, the coordination of community-based support services, and other resources.
c. Charts member's treatments and progress in accordance with state regulations and department procedures.
d. Makes referrals to case manager, as appropriate, and/or refers member's family to community support services and resources.
2. Provides home assessment to high-risk members and develop an individual care plan
3. Collaborates with physicians in screening and evaluating members for psychotropic medications.
4. To better serve members and implement the model of care, understands the clinical program design, program monitoring and reporting.
5. Practices as an interdependent member of the health team and provides important components of primary health care through direct social work services, consultation, collaboration, referral, teaching, and advocacy.
6. Assess' and treats outpatients in individual and family modalities exercising mature professional judgment and using a wide range of social work skills to include individual and family counseling to assist patients and their families in dealing with chronic and acute diseases/injuries.
7. Conducts psychosocial assessments to determine patient needs and resources (both family support and community support). Provides counseling to patient and family in matters directly related to patients' limitation, adjustment to medical condition, and ongoing treatment. Develops and implements discharge plans, follow-up care, and transfers to other health care facilities (e.g., nursing homes, rehabilitation hospitals, etc.)
8. Provides consultation services to medical, nursing, and ancillary hospital staff regarding psychosocial issues, discharge plans, and follow-up care for patients and families.
9. Provides crisis intervention services.
10. Responds independently, and with various media, to appropriate community requests. Take the initiative in seeking out opportunities to present programs to meet the needs of patients/members and their families.
11. Consults with Hospital administration, and Plan supplying information and feedback regarding procedures and services provided by the Psychology Division.
12. Develops and maintains working relationships with community resources. Coordinate with physicians, and representatives of their service disciplines for the benefit of the member and their families. Take initiative in identifying and assessing the needs of the community and organize responses to address those needs.
13. Interfaces with the RN Case Manager(s) and the Interdisciplinary Team (IDT) in the development and implementation of the Case Management Program (CMP).
14. Integrates social work case management and nurse case management as a team.
Job Requirements:
Experience:
• Required: Minimum 5 years of experience in care management, assessment, long term member/patient care management or community based resource delivery. 2 year experience with vulnerable adults or older adult population. 1 year experience with motivational interviewing-Ability to apply Motivational Interviewing and Appreciative Inquiry.
Education:
• Required: Master's Degree in Social Work (MSW)
Training:
• Preferred: Crisis intervention training
Specialized Skills:
• Required:
Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
Intermediate to advanced computer skills and experience with Microsoft Word and Excel.
Skill to understand current and potential needs of members to take appropriate action in order to support member in health and well-being changes.
Skill in building trust in partnership with member/client/patient.
Basic knowledge of complex care management and care management principles.
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly
Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
Report Analysis Skills: Comprehend and analyze statistical reports.
Licensure:
Required:
Current, valid, unrestricted California Driver's License and reliable transportation.
Preferred:
Valid unrestricted Social Worker license (LCSW)
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1 While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2 The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $77,905.00 - $116,858.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries 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 at ******************************* If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email ******************.
$77.9k-116.9k yearly Auto-Apply 58d ago
Clinical Education, Director (APC)
Alignment Healthcare 4.7
Alignment Healthcare job in Orange, CA
Clinical Education, Director APC
External Description:
Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.
By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.
The Alignment Care Anywhere program is a physician-led and advanced practice clinician-driven program that is intended to care for and support Alignment Healthcare patients by proactively providing an additional level of medical and social support via various modalities, including in the comfort of their home, Alignment Clinic, or telehealth visits. This program provides patients with medical and social support when and where they need it, with the goal of preventing unnecessary hospitalizations, health complications, and unmanaged disease progression that can occur when timely clinical interventions are not provided or are not accessible. Our clinic, home-based, and telehealth programs are offered to eligible patients at no cost to them.
Position Summary:
In collaboration with the Care Anywhere (CAW) Clinical Leadership Team, the Clinical Education Director provides clinical education, evaluation, and systems training to new and existing clinical staff, including Nurse Practitioner, Physician Assistant, and Physicians and is responsible for superior clinical outcomes for the Care Anywhere Program. We believe that the best clinical trainers continue to provide patient care which allows them the ability to test, edit, and optimize workflows, so this position will require maintaining a smaller patient panel assignment.
General Duties/Responsibilities:
(May include but are not limited to)
In collaboration with the Clinical Education Director, is responsible for new hire onboarding and training of Nurse Practitioners and Physician Assistants. Provides educational leadership to patients and care providers to enhance specialized patient care within established clinical protocols.
Works closely with Physicians, Nurse Practitioners and Physician Assistants to ensure that they know how to appropriately use the Patient 360 Form to help guide clinical focus and improve clinical documentation.
Collaborates with medical providers and patient care staff in the planning, implementation, and delivery of educational curriculum.
Will spearhead and develop initial onboarding educational content as well as ongoing training to provide refresher training and new content
Will develop a year-long training schedule that will focus on key topics and clinical training protocols to be reviewed on a monthly, quarterly, and annual basis for new and established providers.
Initiates clinical skills development programs within the parameters of established clinical and preceptorship models; monitors trends and implements educational strategies to ensure compliance with quality standards and parameters.
With direction from CAW Clinical Leadership Team, this position supports the clinical team based on policies and procedures that conform to current standards of practice, company philosophy, and operational policies while maintaining compliance with state and federal laws and regulations.
Works closely with AHC clinical leaders, regularly discussing any concerns regarding utilization of services or complicated cases.
Educates technical and patient care staff in the use of new equipment, supplies, and instruments; coordinates in-service training and workshops for appropriate staff.
Ensures proper care in the use and maintenance of equipment and supplies; promotes continuous improvement of workplace safety and environmental practices.
Responsible for retention of current clinical team and working proactively with CAW leadership to help support and mentor NPs and PAs.
Will report all findings to the CAW Clinical Leadership Team or appropriate company executive for final decision.
Performs direct patient care as assigned
Minimum Requirements:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Minimum Experience:
5+ years related experience with clinical emphasis for Nurse Practitioner or Physician Assistant; or any combination of education and experience, which would provide an equivalent background.
Minimum of 1-year experience leading clinical staff, preferably within a high-risk clinic and/or home-based care delivery environment
Current unrestricted state license and current state driver's license
Knowledge of CPT, ICD-9 and HCPC codes
Knowledge of clinical standards of care
Awareness of UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems, is helpful
Passion for geriatric patient care
Comfortable with providing home-based care/home visits
Ability to travel up to 50% local and nationally
Ability to manage multiple new-hires and prioritize training needs
Ability to work independently to meet company goals and timelines
Strong interpersonal and technical presentation skills
Skilled in identifying and resolving problems
Proficient at verbal and written communication
Detail oriented and accurate
Demonstrated compatibility with Alignment's mission and operating philosophies
Demonstrated ability to read, write, speak, and understand the English language
Knowledge of related accreditation and certification requirements.
Ability to assess educational needs and design and develop training content and material
Working knowledge of the use of established clinical and preceptorship models in the development of clinical education programs.
Ability to plan, implement, and evaluate individual patient care programs.
Highly developed verbal and written communication skills and the ability to present effectively to small and large groups.
Strong interpersonal skills and ability to work effectively at all levels in a collaborative team environment.
Intermediate-level computer proficiency including Outlook, EMR- AllScripts and EPIC, and equipment such as iPad, and iPhone
Supervisory Responsibilities:
None
Education/Licensure:
Master's Degree or higher in Nursing OR Graduate of an accredited Physician's Assistant program required.
Current unrestricted RN license and NP license in applicable state OR PA license in applicable state and current NCCPA certification required.
Prescribing authority/DEA licensure in good standing as required in the state in which you are applying preferred.
Other:
EMR experience is strongly preferred.
Must be able to work a flexible schedule and travel as needed.
Preferred:
Experience in gerontology, adult care
Home care or home visit experience
Excellent administrative, organizational, and verbal skills
Effective communication skills with seniors
Ability to work independently
Detail-oriented
Dependable and reliable
Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.
If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact ******************.
City: Orange
State: California
Location City: Orange
Schedule: Full Time
Location State: California
Community / Marketing Title: Clinical Education, Director (APC)
Company Profile:
Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.
By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.
EEO Employer Verbiage:
On August 17, 2021, Alignment implemented a policy requiring all new hires to receive the COVID-19 vaccine. Proof of vaccination will be required as a condition of employment subject to applicable laws concerning exemptions/accommodations. This policy is part of Alignment's ongoing efforts to ensure the safety and well-being of our staff and community, and to support public health efforts. Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran. If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact ******************.
$96k-134k yearly est. Easy Apply 60d+ ago
Data Engineer Architect
Alignment Healthcare 4.7
Alignment Healthcare job in Anaheim, CA
Architect, Data Engineering
External Description:
Architect, Data Engineering
Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.
By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.
Position Summary:
Alignment Healthcare is a data and technology driven healthcare company focused partnering with health systems, health plans and provider groups to provide care delivery that is preventive, convenient, coordinated, and that results in improved clinical outcomes for seniors.
We are experiencing rapid growth (backed by top private equity firms), our Data and Analytics(D&A) team is looking for the best and brightest leaders. Data drives the way we make decisions. We love our customers and understanding them better makes it possible to provide the best clinical outcome and care experience.
As Architect of Data Engineering, you will play a key role in architecting data engineering solutions and technology to uncover deep insights from data using big data technologies and advanced statistical analysis, processing very large data sets using cloud-based data pipelines(real-time and batch) on Microsoft Azure, variety of analytic tools, visualizations and delivering actionable healthcare insights & solutions. You will also be assisting with integrating the SQL data warehouse platform as our primary processing platform to create the curated enterprise data model for the company to leverage.
General Duties/Responsibilities:
(May include but are not limited to)
Architects, develops, and implements Data Engineering strategy to support organizational initiatives.
Leads the architecture function of Data Engineering (Pipeline) team
Provides leadership, mentorship to internal data Engineering staff.
Lead the effort for building and migrating the complex ETL/EDI pipelines from on premise system to cloud and Hadoop/Spark/Kafka to make the system grow elastically
Ensuring data quality throughout all stages of acquisition and processing, including data collection, ground truth generation, normalization and transformation
Extracting and combining data from various heterogeneous data sources
Designing, implementing and supporting a platform that can provide ad-hoc access to large datasets
Modelling data and metadata to support machine learning and AI
Build statistical models, apply machine learning techniques, analyze very large data sets and construct metrics using these modeling techniques.
Guiding critical business decisions by highlighting opportunities, identifying correlations, defining experiments and figuring out cause and effect relationships.
Deploying models in operational software to power insights and actions.
Develop experimental and analytic plans for data modeling processes, use of strong baselines, ability to accurately determine cause and effect relations
Provide leadership to Data Engineering teams.
Communicate with business partners, software vendors, and internal departments.
Participate in project meetings, providing input to project plans and providing status updates.
Responsible for the global standardization of Data Engineering processes and process improvement and efficiency
Minimum Requirements:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Minimum Experience:
6+ years relevant experience in Data Engineering.
3+ years of architecture experience
Experience with machine learning algorithms, including deep neural networks, natural language processing, kernel methods, dimensionality reduction, ensemble methods, hidden Markov models and graph algorithms.
Data Warehousing Experience with SQL Server, Oracle, Redshift, Teradata, etc.
Experience with Big Data Technologies (NoSQL databases, Hadoop, Hive, Hbase, Pig, Spark, Elasticsearch, Databricks etc.)
Experience with real-time data processing and API platforms.
Experience in using Python, Java and/or other data engineering languages
Experience with data visualization and presentation, turning complex analysis into insight.
Healthcare domain and data experience
Education/Licensure:
Masters in Computer Science, Engineering, Mathematics, Statistics, or related field
Other:
Demonstrated ability in data modeling, ETL development, API developments and data warehousing.
Knowledge and experience of SQL and SSIS.
Excellent communication, analytical and collaborative problem-solving skills
Preferred:
PhD or Master's in computer science, Electrical Engineering, Mathematics, Statistics, or related field
Industry experience as a Data Engineering Leader or related specialty (e.g., Software Engineer, Business Intelligence Engineer, Data Engineer) with a track record of manipulating, processing, and extracting value from large datasets.
Experience building/operating highly available, distributed systems of data extraction, ingestion, and processing of large data sets
Experience building data products incrementally and integrating and managing datasets from multiple sources
Experience leading large-scale data warehousing and analytics projects, including using Azure or AWS technologies - SQL Server, Redshift, S3, EC2, Data-pipeline, Data Lake, Data Factory and other big data technologies
Experience providing technical leadership and mentor other engineers for the best practices on the data engineering space
Linux/UNIX including to process large data sets.
Experience with Azure, AWS or GCP is a plus
Microsoft Azure data architecture Certification is a plus
Demonstrable track record dealing well with ambiguity, prioritizing needs, and delivering results in an agile, dynamic startup environment
Knowledge of scripting for automation (e.g. Python, Perl, Scala etc.)
Experience with NoSQL, Spark, Hadoop, Elasticsearch etc.
Demonstrable track record dealing well with ambiguity, prioritizing needs, and delivering results in an agile, dynamic startup environment
Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
City: Anaheim
State: California
Location City: Anaheim
Schedule: Full Time
Location State: California
Community / Marketing Title: Data Engineer Architect
Company Profile:
Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.
By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.
EEO Employer Verbiage:
On August 17, 2021, Alignment implemented a policy requiring all new hires to receive the COVID-19 vaccine. Proof of vaccination will be required as a condition of employment subject to applicable laws concerning exemptions/accommodations. This policy is part of Alignment's ongoing efforts to ensure the safety and well-being of our staff and community, and to support public health efforts. Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran. If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact ******************.
$117k-150k yearly est. Easy Apply 60d+ ago
Utilization Management Coordinator
Alignment Healthcare 4.7
Alignment Healthcare job in Orange, CA
Utilization Management Coordinator
External Description:
Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.
By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.
Position Summary:
The Utilization Management (UM) Clerk will assist in the clerical support to the UM department staff (i.e. incoming/outgoing mail, data entry, filing, etc.)
General Duties/Responsibilities:
(May include but are not limited to)
· Responsible for processing incoming and outgoing mail for the UM Department.
· Maintains inventory of office supplies at a level necessary for proper functioning of the department.
· Performs clerical duties deemed necessary to ensure smooth functioning of the department.
· Performs data entry as requested.
· Assist Inpatient team by entering Face Sheets and faxes.
· Data integrity testing for new projects or project enhancement
· Ensures delegated IPA/MGs provide CCHP with discharge dates, authorized days and discharge disposition on members assigned to delegated IPA/MG by faxing requests for information, tracking receipt of information and forwards information to Inpatient Team.
· Call hospitals to obtain billing charges and maintain billing log.
· Meets specific deadlines (responds to various workload by assigning task priorities according to department policies, standards, and needs).
· Maintain Department miscellaneous filing in an organized fashion as well as create files as needed.
· Recognizes work-related problems and contributes to solutions.
· Maintains confidentiality of information between and among health care professionals.
· Other duties as assigned by UM Management.
Minimum Requirements:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Minimum Experience:
a. Minimum of one-year in clerical support.
2. Education/Licensure:
a. High school diploma or general education degree (GED)
b. At least six months related experience and/or training; or equivalent combination of education and experience.
3. Other:
a. Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence.
b. Mathematical Skills: Ability to add and subtract two digit numbers and to multiply and divide with 10's and 100's. Ability to perform these operations using units of American money and weight measurement, volume, and distance.
c. Typing speed 45 wpm and proficient use of 10-key calculator.
d. Computer Skills: Microsoft Office. Knowledge of computer programs and applications required.
e. Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.
i. Excellent communication skills, oral and written.
4. Work Environment
a. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
i. The noise level in the work environment is usually moderate.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
2. The employee is frequently required to walk; stand; reach with hands and arms.
3. The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.
4. The employee must occasionally lift and/or move up to 20 pounds.
5. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.
If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact ******************.
City: Orange
State: California
Location City: Orange
Schedule: Full Time
Location State: California
Community / Marketing Title: Utilization Management Coordinator
Company Profile:
Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.
By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.
EEO Employer Verbiage:
On August 17, 2021, Alignment implemented a policy requiring all new hires to receive the COVID-19 vaccine. Proof of vaccination will be required as a condition of employment subject to applicable laws concerning exemptions/accommodations. This policy is part of Alignment's ongoing efforts to ensure the safety and well-being of our staff and community, and to support public health efforts. Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran. If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact ******************.
$59k-72k yearly est. Easy Apply 60d+ ago
Data Engineering Manager
Alignment Healthcare 4.7
Alignment Healthcare job in Orange, CA
Manager; Data Engineering
External Description:
Title: Manager, Data Engineering
Alignment Healthcare is a data and technology driven healthcare company focused partnering with health systems, health plans and provider groups to provide care delivery that is preventive, convenient, coordinated, and that results in improved clinical outcomes for seniors.
We are experiencing rapid growth (backed by top private equity firms), our Data and Analytics(D&A) team is looking for the best and brightest leaders. Data drives the way we make decisions. We love our customers and understanding them better makes it possible to provide the best clinical outcome and care experience.
As Manager of Data Engineering, you will play a key role in managing data engineering functions to uncover deep insights from data using big data technologies and advanced statistical analysis, processing very large data sets using cloud-based data pipelines on Microsoft Azure, variety of analytic tools, visualizations and delivering actionable healthcare insights & solutions. You will also be assisting with integrating the SQL data warehouse platform as our primary processing platform to create the curated enterprise data model for the company to leverage.
Responsibilities:
Develops and implements Data Engineering strategy to support organizational initiatives.
Manages and leads the Data Engineering Team (Pipeline) team
Provides leadership, mentorship to internal data Engineering staff.
Lead the effort for building and migrating the complex ETL/EDI pipelines from on premise system to cloud and Hadoop/Spark to make the system grow elastically
Ensuring data quality throughout all stages of acquisition and processing, including data collection, ground truth generation, normalization and transformation
Extracting and combining data from various heterogeneous data sources
Designing, implementing and supporting a platform that can provide ad-hoc access to large datasets
Modelling data and metadata to support machine learning and AI
Build statistical models, apply machine learning techniques, analyze very large data sets and construct metrics using these modeling techniques.
Guiding critical business decisions by highlighting opportunities, identifying correlations, defining experiments and figuring out cause and effect relationships.
Deploying models in operational software to power insights and actions.
Develop experimental and analytic plans for data modeling processes, use of strong baselines, ability to accurately determine cause and effect relations
Provide leadership to Data Engineering teams.
Communicate with business partners, software vendors, and internal departments.
Participate in project meetings, providing input to project plans and providing status updates.
Responsible for managing Data Engineering functions to ensure that the project costs are achieved within budget
Responsible for the global standardization of Data Engineering processes and process improvement and efficiency
Basic Qualifications:
Masters in Computer Science, Engineering, Mathematics, Statistics, or related field
6+ years relevant experience in Data Engineering.
2+ years of delivery management and architecture experience
Experience with machine learning algorithms, including deep neural networks, natural language processing, kernel methods, dimensionality reduction, ensemble methods, hidden Markov models and graph algorithms.
Demonstrated ability in data modeling, ETL development, and data warehousing.
Data Warehousing Experience with SQL Server, Oracle, Redshift, Teradata, etc.
Experience with Big Data Technologies (NoSQL databases, Hadoop, Hive, Hbase, Pig, Spark, Elasticsearch etc.)
Experience in using Python, Java and/or other data engineering languages
Knowledge and experience of SQL and SSIS.
Excellent communication, analytical and collaborative problem-solving skills
Experience with data visualization and presentation, turning complex analysis into insight.
Excellent communication, analytical and collaborative problem-solving skills
Healthcare domain and data experience
Must be familiar with HIPAA 5010 Transaction sets (834, 835, 837, 820, 270, 271, 276 etc.) as well as Clinical HL7 (ADT, CCD, CDA, etc.) transaction sets.
Preferred Qualifications:
PhD in Computer Science, Electrical Engineering, Mathematics, Statistics, or related field
Industry experience as a Data Engineering Leader or related specialty (e.g., Software Engineer, Business Intelligence Engineer, Data Engineer) with a track record of manipulating, processing, and extracting value from large datasets.
Experience building/operating highly available, distributed systems of data extraction, ingestion, and processing of large data sets
Experience building data products incrementally and integrating and managing datasets from multiple sources
Experience leading large-scale data warehousing and analytics projects, including using Azure or AWS technologies - SQL Server, Redshift, S3, EC2, Data-pipeline, Data Lake, Data Factory and other big data technologies
Experience providing technical leadership and mentor other engineers for the best practices on the data engineering space
Linux/UNIX including to process large data sets.
Experience with Azure, AWS or GCP is a plus
Microsoft Azure Certification is a plus
Demonstrable track record dealing well with ambiguity, prioritizing needs, and delivering results in an agile, dynamic startup environment
Knowledge of scripting for automation (e.g. Python, Perl, Scala etc.)
Experience with NoSQL, Spark, Hadoop, Elasticsearch etc.
Demonstrable track record dealing well with ambiguity, prioritizing needs, and delivering results in an agile, dynamic startup environment
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
City: Orange
State: California
Location City: Orange
Schedule: Full Time
Location State: California
Community / Marketing Title: Data Engineering Manager
Company Profile:
Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.
By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.
EEO Employer Verbiage:
On August 17, 2021, Alignment implemented a policy requiring all new hires to receive the COVID-19 vaccine. Proof of vaccination will be required as a condition of employment subject to applicable laws concerning exemptions/accommodations. This policy is part of Alignment's ongoing efforts to ensure the safety and well-being of our staff and community, and to support public health efforts. Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran. If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact ******************.
$136k-171k yearly est. Easy Apply 60d+ ago
Bilingual Spanish Health Coach and Educator (Conduct Home Visits in LA/OC, CA w/ Mileage Reimbursement)
Alignment Healthcare 4.7
Alignment Healthcare job in Los Angeles, CA
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
Alignment Health is seeking an organized, compassionate, and motivated bilingual Spanish Health Coach and Educator to join the interdisciplinary Care Anywhere team in Los Angeles / Orange County, California. As a Health Coach & Educator you will conduct home and virtual (telehealth and telephonic) visits to develop a wellness coaching relationship with patients, caregivers, and families through the process of actively working towards better health by providing support, encouragement, and education.
- Must conduct between 6-8 home visits per day.
- Mileage reimbursement provided from the time you leave home to the time you return.
Schedule: Monday - Friday, 8:00 AM - 5:00 PM Pacific Time
GENERAL DUTIES / RESPONSIBILITIES:
1. Contacts patients that are eligible for Alignment's Care at Home program and provides necessary wellness coaching to reduce or eliminate high-risk behaviors
2. Collaborates with advanced practice clinicians and/or social worker to develop an action plan
3. Encourages adoption of habits that are conducive to a higher quality of life
4. Responsible for delivering a high level of patient service and increasing member retention and satisfaction
5. Assists patients with accessing community resources and social services to address social determinants impacting health and wellbeing
6. Develops and distributes health education materials to identified patients, caregivers, and/or families
7. Coordinates Care with other Alignment team members, including health-related vendors for optimal patient care
Minimum Requirements:
Experience:
• Required: Minimum 1+ year of experience as a wellness or health coach or educator
• Preferred: Senior care experience.
Education:
• Required: High School Diploma or GED. Associate's degree or two years additional experience in lieu of education.
• Preferred: Bachelor's Degree
Specialized Skills:
• Required:
Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
Solid knowledge of specific diseases, lifestyle-related topics, nutrition, and exercise
Knowledge of and experience with applying the stages of change or a similar behavior change model
Excellent interpersonal skills with the ability to foster trust and respect among customers and coworkers.
Able to work independently and remotely.
Able to work with protected health information and maintain absolute confidentiality and privacy in accordance with HIPAA regulations and AHP policies
Proficient computer skills including Microsoft Office Excel, Word and PowerPoint
Ability to work a flexible schedule
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly
Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
• Preferred: Bilingual English and Spanish
Licensure:
• Required: Current and valid California Driver's License and reliable transportation.
Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $48,373.00 - $72,559.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries 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 at ******************************* If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email ******************.