Behavioral Health Specialist (LCSW/LPC/Psychologist)
Neighborhood Health Centers of The Lehigh Valley 4.3
Remote
The Behavioral Health Specialist (Licensed Clinical Social Work (LCSW), Licensed Professional Counselor (LPC), and/or Psychologist) will be an integral member of the NHCLV multidisciplinary team to provide mental health treatment for patients in the Integrated Behavioral Health program at NHCLV. The Behavioral Health Specialist educates patients about mental illness through the use of psychoeducation and provides mental health counseling within individual, family, couples, and group counseling settings. The Behavioral Health Specialist works closely with the primary care provider, behavioral health care managers, integrated behavioral health care navigators, and a consulting psychiatrist to revise the wellness/treatment plan when patients are not improving, and offer alternatives as needed to support treatment. The Behavioral Health Specialist will evaluate, assess, and support the patient in the office, their home, and community as needed. The Behavioral Health Specialist will utilize patient centered, family focused therapy using a variety of treatment modalities such as Cognitive Behavioral Therapy (CBT) and Solution Focused therapy.
QUALIFICATIONS
Master's degree in social work, psychology, human services, or related field.
Licensed in the state of Pennsylvania. At least two years of experience as a Behavioral Health Specialist (LCSW, LPC, and/or Psychologist).
Minimum two years of counseling related experience.
Capacity to work with families in a confidential, respectful, caring, professional manner.
Competency in Spanish Language ability (spoken/written) preferred.
Strong communication skills both verbal and written.
Adequate computer skills required (MS Office, web based software, and some knowledge of electronic health records system).
Must have strong interpersonal skills.
Excellent organizational skills needed.
Must be able to work independently and as part of a team.
Valid driver's license and car that is insured is required.
WORKING CONDITIONS
Hours of Operation: Between 7:30am - 8:00pm as scheduled based on patient needs. Evening and weekend hours possible. Full-time, salaried exempt position with occasional evening meetings and regular evening clinical hours expected but not greater than 3 days per week; rotating weekend hours required not to exceed 2 weekends per month. Clinician shall share call and coverage obligations on a substantially equal basis with the other Clinician-employees of the Corporation.
Other: Off-site work at other program sites and patient homes. Out-of-town and overnight trips possible
PA Criminal Clearance, PA Child Abuse Clearance and FBI dated from within the past year. A credit history is needed for any role who directly handles agency funds.
MMR, Varicella, Tdap, Tuberculosis (2 PPDs or QuantiFERON TB Gold), Hepatitis B, Influenza and Covid Vaccinations.
Other credentialing requirements may be required depending on the role.
$35k-52k yearly est. 60d+ ago
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Customer Service Representative - Must live in Nevada
Alignment Healthcare 4.7
Remote
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 Regional Concierge Navigator provides outreach and support to all our members, ensuring they have access to the care they deserve. Supports our members to navigate through their health care and benefits. Connects the dots between our provider network, health plan operations, and supplemental vendors. Maintains a high knowledge of the member needs of their respective market and assist our members every step of the way to ensure they are never alone in their healthcare journey and have the highest level of coordinated care. Lays the groundwork for future and ongoing member support. Has familiarity with assigned markets and understands the meaningful contributions to members' healthcare outcomes.
ENERAL DUTIES/RESPONSIBILITIES
1. Provides in-market, specialized member support in respective market or region.
2. Conducts in-market member engagement including Welcome Calls, New Member Onboarding, JSA Scheduling, High Quality PCP and Provider Terms, Product/Vendor Changes, CAHPS Proxy, Disenrollment Quality Assurance, and Proactive Service Recovery
3. Conducts case follow-ups and quality member issue resolution for all cases assigned.
4. Ensures members have access to PCP and specialists to coordinate care.
5. Educates members on gaps in care and assists with scheduling provider appointments.
6. Serves as the patient's liaison throughout the life cycle of the program by addressing program specific quality measures and adhering to company guidelines/standard operating procedures.
7. Makes appropriate and timely patient appointments, reminders, and confirmations and Mails letters and correspondence as needed.
8. Places regular/consistent outreaches to the patient
9. Communicates with PCP with any member updates and requests.
10. Assists with obtaining medical records from any healthcare providers involved in care or hospitals.
11. Helps members with any authorizations and referrals involved in their care plan.
12. Resolves 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.
13. Participates in on-site member engagement activities as needed, such as in-person member meetings, handling lobby calls at a retail or care center location, etc. (subject to change).
14. Other duties as assigned.
Job Requirements:
Experience:
• Required: Minimum 1 year of customer service experience.
• Preferred: 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.
Education:
• Required: High School Diploma or GED.
Specialized Skills:
• Required:
Knowledge of ICD-10 and CPT codes.
Keyboard typing 40+ words per minute.
Ability to help members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations.
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.
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.
Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly
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 English/Vietnamese or English/Mandarin. Fluency in written and verbal Spanish, Korean, or Vietnamese, a plus.
Licensure:
• Required: None
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: $41,654.00 - $62,482.00
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 ******************.
$41.7k-62.5k yearly Auto-Apply 60d+ ago
Operating Room Coordinator
Healthpartners 4.2
Remote
Regions Hospital has an opportunity for an Operating Room Coordinator to join our team!
This position works collaboratively with Surgical staff to coordinate care of surgical patients and communicate with patients/families. This role requires a high level of competence in utilizing complex specialized Operating Room and other computer systems, excellent telephone etiquette, and strong communication and interpersonal skills with a customer service focus. Specific areas of responsibility will be assigned most of the time; but may be assigned to cover all areas as directed. Performs other duties as assigned.
At Regions Hospital you'll find a warm, diverse group of people who are committed to helping our patients - and each other. We foster an inclusive environment that encourages new ways of thinking, celebrates differences and recognizes hard work. We're also committed to living our values. This means you can expect us to be your partner and treat you with dignity and respect. Join our team and make good happen!
Thank you for considering joining our team at Regions Hospital and being part of something special!
Minimum Qualifications:
Three (3) years of computer/data entry experience. Medical or surgical background preferred.
$34k-43k yearly est. Auto-Apply 60d+ ago
Manager, Utilization Management (Coordination)
Alignment Healthcare 4.7
Remote
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 51d ago
Utilization Management Physician Advisor, CA Licensed (Part Time)
Alignment Healthcare 4.7
Indiana jobs
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.
***MUST HAVE CALIFORNIA LICENSE***
***MUST HAVE UTILIZATION MANAGEMENT EXPERIENCE***
Utilization Management Physician Advisor works with Senior Medical Officers, Regional Medical Officers, Extensivists, the Healthcare Services Team (Case managers, Social Workers, Utilization Managers) to develop and implement methods to optimize use of Institutional and Outpatient services for all patients while also ensuring the quality of care provided. Through remote access to our web-based Portal, physician advisors will complete clinical reviews for medical necessity, treatment appropriateness and compliance.
GENERAL DUTIES/RESPONSIBILITIES:
Perform medical necessity utilization reviews primarily for inpatient and post-acute cases with some outpatient / pre-service reviews as needed in accordance with UM guidelines Lead concurrent review activities, including rounds, peer-to-peers, and utilization management strategies to improve clinical and efficiency outcomes Serve as a clinical leader and educator for the nursing / care management team Process claims reviews, appeals, and second-level reviews as needed in compliance with Medicare (NCD, LCD), internal, and third-party guidelines (e.g., MCG) for Inpatient, Outpatient, Skilled Facilities Level of Care and Pharmacy. Acts as a liaison between the medical staff, utilization review team, and 3rd parties to effectively promote clinically necessary and efficient utilization of care Serves as a Physician member of the utilization review team. Work with Interdisciplinary Teams to help manage complex or high risk cases Contributes to development of clinical strategies to improve member outcomes, efficiency metrics, and quality outcomes Duties may include serving on committees as needed, such as quality, utilization management, credentialing, etc Other duties as may be assigned to the medical director.
Supervisory Responsibilities:
Oversees assigned staff, if any. Responsibilities may include recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees.
Experience:
• Required: Minimum of 3 years of experience in hospital-wide or skilled nursing facility position involving clinical care, quality management, utilization / case management, or medical staff governance required
• Preferred: Experience as a Physician Advisor or Medical Director a plus
Education:
Required: Completion of medical school and specialty residency (preferably in internal medicine).
Preferred: Board-certification
Specialized Skills:
• Required:
Utilization Management Experience
Ability to build rapport with medical staff and management leadership to obtain necessary approvals of new strategies for utilization management.
Knowledge of current medical literature, research methodology, healthcare delivery systems, healthcare financial/reimbursement issues, and medical staff organizations.
Dedication to the delivery of high-quality, cost-effective, efficient patient care services
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.
Licensure:
• Required: California License, Applicants must have current, non-restricted licensure as required for clinical practice in the state of California.
Work Environment:
This is a remote position. 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.
2 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.
3 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:
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 ******************.
$64k-92k yearly est. Auto-Apply 11d ago
Application Analyst and Developer, Epic Client Systems Administrator (ECSA)
Healthpartners 4.2
Ann, MN jobs
HealthPartners is hiring an Application Analyst and Developer, Epic Client Systems Administrator (ECSA) on the Epic Core Team. The ECSA is responsible for installation, configuration, upgrades, support, monitoring, and maintenance for Epic Client Systems infrastructure. This is a full-time position with an option of working remote or on site.
The Epic Core Team is responsible for managing Epic environments, Epic Client System Administration, Epic print set up, Epic Data Courier Admin, etc. The Epic Core Team works closely with our Cache DBA's, Virtual Hardware System team, Application Deployment team as well as Desktop, End User Computing, and a Support Center. This position ensures that the appropriate analysis and technical requirements are documented for applications changes. The person in this position is responsible for documenting, coding, and assessing application changes for larger application changes that may have minimal interfaces with other applications and systems.
ACCOUNTABILITIES:
* Assesses builds and deploys software and new application functionality.
* Performs unit testing and assists with system and end-user test planning and testing.
* Develops and/or assists with test scripts; may manage the testing process or advise business partners on testing components.
* Analyzes functional and technical requirements for moderate changes or enhancements and updates system designs and specifications.
* Diagnoses system failures and corrects issues.
* Drafts technical specifications based on identified business requirements.
* Supports 3rd party application software; interacts with vendors regarding problems, upgrade schedules, and software installations.
* Provides requested documentation and interviews with auditors and third-party requestors.
SKILLS/EXPERIENCE:
* Working knowledge of programming languages
* Strong experience with Microsoft Office tools
* Strong understanding of IT infrastructure
* Proven ability to gather requirements and deliver output on those requirements
* Strong communication skills in technical and non-technical vernacular
* Proven ability to write technical documentation in a clear manner
* Experience participating on project teams, preferably from initiation through successful implementation and acceptance of application changes
* Expertise with more than one system development methodologies
* Excellent analysis and problem-solving skills
* Able to be on-call 24X7 in areas of expertise
REQUIRED QUALIFICATIONS:
* Bachelor's degree in Computer Science, Business Administration, Management Information Systems or equivalent experience/training
* 3+ years IT analysis and technical design experience
* 1+ year experience coding, testing, and implementing program changes
PREFERRED QUALIFICATIONS:
* 1 year of healthcare/ health plan experience
#LI-Remote
$69k-82k yearly est. Auto-Apply 43d ago
Community Outreach Representative
Alignment Healthcare 4.7
Greensboro, NC jobs
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 Community Outreach Representative is responsible for generating local community brand awareness of the health plan with accountabilities in driving leads and sales (direct or indirect) through grass roots efforts. Acts as the face of Alignment Health Plan in their assigned market or geography.
Job Duties/Responsibilities:
1. Meets or exceeds weekly and monthly qualified lead goals.
2. Helps local market achieve monthly sales goals; works with direct sales teams in lead development and public facing presentations (advertised or non-advertised)
3. Cultivates new and maintains existing relationships with key senior and community influencers that cul-minate into lead generating events/activities and increase of name awareness for Alignment and its prod-ucts.
4. Sets-up and attends monthly events and activities through in-person visits, via telephone contact and through email, sources, plans. Events and activities include health fairs, presentations and or seminars at senior centers, food banks, churches, senior living facilities, various community organizations etc.
5. Distributes approved marketing and event materials. Works with Corporate Marketing and Compliance Departments in the approval, development, and production of advertising materials and or invitations for events.
6. Locates, plans, sets-up, attends and presents at Quarterly New Member Orientations and year-round Edu-cation events (as needed in a non-virtual event) in the local community.
7. Educates the community on Alignment and its benefits, services and contracted providers and medical groups IPAs available to prospects.
8. Promotes and increases name awareness and brand identity for Alignment and its products.
9. Provides monthly calendar of their planned activities and ensures that all scheduled events filed
10. Maintains weekly summary of activity and submits report on a weekly basis.
11. Performs special projects as assigned to help drive leads for the company.
12. Conducts and leads advertised sales meetings in their territory.
13. Calls on local Doctor offices to educate on the Alignment products and distribute flyers to generate refer-rals.
14. Other Duties as assigned.
Job Requirements:
Experience:
• Required: Minimum two (2) years of experience in grass roots marketing efforts generating leads at local in-person community events.
• Preferred: 5+ years' experience in Healthcare. Healthcare marketing experience. Related experience in the Medicare and Medi-Cal Managed Care industry.
Education:
• Required: High School Diploma or GED. Bachelor's degree or four (4) 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.
Computer Skills: Proficient user in MS office suite (Word, Excel and PowerPoint).
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: Valid State driver's license, car insurance, and registration
• Required: State Insurance license OR become licensed within 6 months of hire date
Other:
• Required:
80% or more travel by car routinely required (In assigned market).
Travel by plane required as needed.
Maintenance of reliable means of transportation and
Extended works hours, as needed.
Fully Vaccinated
Remote work on approval.
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 accommodation 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: $49,486.00 - $74,228.00
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 ******************.
$49.5k-74.2k yearly Auto-Apply 13d ago
Musculoskeletal or General Radiology Physician - Evenings - suburban Minneapolis, MN (remote available)
Healthpartners 4.2
Saint Louis Park, MN jobs
Park Nicollet
Musculoskeletal or General Radiology Physician - Evenings - suburban Minneapolis, MN (remote available)
Park Nicollet is looking for a MSK or General Radiologist to join our team.
As a Park Nicollet Radiologist, you will be part of the largest multi-specialty care system in the Twin Cities. The position requires board certification/board eligibility in Radiology. This is a partnership-track position to fill shortened evening shifts. Remote (options limited by state of residence) and local options are available. Imaging responsibilities would extend as late as 10 pm central time. Weekend responsibilities would be 1 in 6.
The Radiology Department consists of 47 physicians and 5 physician assistants, providing coverage to both outpatient and inpatient sites. The practice has subspecialty emphasis in interventional radiology, neuroradiology, musculoskeletal radiology and breast imaging. The group benefits from the integration of a multispecialty clinic that has a stable referral population. Salary and benefits are very competitive.
You will be joining a team that is supportive and respectful of one another and deeply committed to the mission of HealthPartners. Here, you'll become a partner for good, helping to improve the health and well-being of our patients, members and community. Our commitment to excellence, compassion, partnership and integrity is behind everything we do. It's the type of work that makes a difference, the kind of work you can be proud of. We hope you'll join us.
TO APPLY:
For immediate consideration, please email CV to Stasi Johnson, Clinician Recruitment, Park Nicollet Health Services, ******************************.
Methodist Hospital is looking to hire a Sterile Processing Tech (SPD) to join our sterile processing team! Come join us as a Partner for Good and help us make an impact on the care and experience that our patients and their families receive every day.
Position Summary:
The Sterile Processing Technician is responsible and accountable for all functions of the sterile processing department, under the guidance of the sterile processing department supervisors and manager.
This position is responsible for working independently and with team members to ensure that all surgical instrumentation are properly decontaminated, assembled, inspected, packaged, sterilized, high level disinfected, marked for repair and placed in a proper repair location, and communicate incomplete trays and missing items to management and OR immediately. All instruments must be distributed, tracked and stored in a safe, secure, aseptic and timely manner throughout the hospital and clinics. Immediate-use steam sterilization, tray turnovers between surgical cases and releasing sterilized loads from the department must be performed observing standard practice. Each team member will be qualified to train others as assigned and serve as a front-line resource to sterile processing customers.
The Sterile Process Tech is part of the SEIU-113 Union - SEIU will offer competitive wages for any prior experience in Sterile Processing or related fields. Please list any prior experience on your resume.
Work Schedule:
1.0 FTE / Evening Shift (3pm-11pm) M-F
Rotating when needed, Rotating Weekends, On-Call Available
Required Qualifications:
Central Service/Sterile Processing/or Surgical Technology program certification with hands-on clinical experience
or
1 year of central service/sterile processing/surgical technology experience.
Word Processing knowledge, typing, data entry, strong communication skills - verbal and written.
The candidate will present current certification from either CBSPD: C.S.P.D.T. or HSPA (formerly known as IAHCSMM): C.R.C.S.T. or must attain one of these certifications within 18 months of hire.
The 18 month deadline will be the set on the same numbered day of the month as the hire date. For hire dates falling on the 31st, the deadline defaults to the last day of the 18th month.
This certification must be maintained for the duration of employment.
Park Nicollet team members who have been employed for 10 consecutive years prior to 2015 with no lapse in employment as Instrument Room Aide/Sterile Processing Department Technician (9AT) and/or Lead Sterile Processing Technician (116-030) will not be required to obtain certification
Benefits:
Park Nicollet offers a competitive benefits package (for eligible positions) that includes medical insurance, dental insurance, a retirement program, time away from work, insurance options, tuition reimbursement, an employee assistance program, onsite clinic and much more!
$32k-40k yearly est. Auto-Apply 60d+ ago
UM Coordinator (Inpatient)
Alignment Healthcare 4.7
Remote
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, detail-oriented and customer service oriented inpatient utilization management (UM) coordinator to join the remote UM team. As an inpatient UM coordinator, you will assist with managing census and admissions, retrieve medical records, and discharge planning while working with the case management (CM) supervisor, manager, and director of healthcare services.
If you are hungry to learn and grow, want to be part of a growing organization, and make a positive impact in the lives of seniors - we're looking for you!
Schedule: Monday - Friday, 8am - 5pm Pacific Time (Required)
GENERAL DUTIES / RESPONSIBILITIES:
Assist team with daily census by entering face sheets for hospitals and skilled nursing facilities (SNF).
Obtain medical records from hospitals and SNF's.
Attach medical records to authorizations.
Enter referral requests / authorizations in system using ICD 10 and CPT coding.
Monitor fax folders.
Complete and document tasks as assigned by nurse.
Maintain documentation on facilities contacted.
Assist with maintaining and updating member's records.
Assist with mailing or faxing correspondence to facilities, related to, as needed.
Request medical records from facilities, etc., related to members activities, as needed.
Attend case management presentations and participates, as appropriate.
Recognize work-related problems and contributes to solutions.
Meet specific deadlines and respond to various workloads by assigning task priorities according to department policies, standards and needs.
Maintain confidentiality of information between and among health care professionals.
Be a positive team player.
Job Requirements:
Experience:
Required:
Inpatient concurrent review experience
Experience with census and admission management
Experience in discharge planning
Experience entering referrals and prior authorizations.
Experience with Medicare Advantage
Experience with hospital and / or facilities backend admissions
Knowledge of medical terminology
Knowledge of ICD10 and CPT codes
Knowledge of Medicare, HMO, MMO, managed care plans
Computer proficient
Preferred:
Medical assistant experience preferred
Knowledge working in Access Express / Portal, Epic preferred.
Education:
Required:
High school diploma or general education degree (GED) or (4) years' additional experience in lieu of education.
Preferred:
Medical Terminology Certificate preferred.
Training:
Required:
Preferred:
Specialized Skills:
Required:
Proficient in Microsoft Office (Outlook, Excel, Word)
Able to type minimum 50 words-per-minute (WPM).
Organized and detail oriented.
File systematically.
Good interpersonal skills.
Strong written, verbal, and telephonic communication skills
Able to read, write, and speak English fluently.
Preferred:
Licensure:
Required: None
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.
2. 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.
3. The employee frequently lifts and / or moves up to 10 pounds.
4. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $41,472.00 - $62,208.00
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 ******************.
$41.5k-62.2k yearly Auto-Apply 33d ago
Provider Engagement Specialist (North Carolina)
Alignment Healthcare 4.7
Remote
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 Provider Engagement Specialist is responsible for developing and maintaining strong relationships with provider offices to improve network performance, enhance provider satisfaction, and support organizational growth. This role partners with providers on strategies to increase patient retention and growth, while also driving performance across key quality and utilization metrics. The Provider Engagement Specialist serves as the main point of contact for providers, offering education, support, and tools to achieve goals.
General Duties/Responsibilities (May include but are not limited to):
Build and maintain collaborative relationships with providers and their staff to support growth, retention, and performance improvement.
Partner with providers to improve performance on key performance indicators (KPIs), including but not limited to growth, retention, Annual Wellness Visits (AWVs), HEDIS gap closures, hospital and ER utilization, risk adjustment and other quality indicators.
Conduct initial provider onboarding and provide support for ongoing provider education on Alignment tools, clinical programs, PCP incentives, Member benefit offerings, Model of Care and other compliance requirements, and Alignment initiatives.
Assist in the development of training and educational materials/tools. Create provider
in-service and implementation packets.
Facilitate and serve as a single point of resolution for provider issues, including but not limited to UM, prior authorization, claims, encounter data, eligibility, provider rosters and directory validation.
Represent Alignment Health at provider meetings, trainings, and community events. Document meeting minutes and action items as needed.
Consistently utilize, update and maintain department databases and tracking tools to ensure provider engagement activities, provider visits and outcomes are documented and monitored.
Negotiate and implement standard physician and ancillary agreements; obtain provider credentialing; utilize network database to track recruitment activity.
Maintain weekly summary of activity and submit reports on a weekly basis.
Attend and participate in all staff meetings as required.
Perform special projects as assigned.
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:
Two years related experience and/or training; or equivalent combination of education and experience.
Experience in provider relations / contracting with an HMO or IPA, medical group or institutional provider required
Education/Licensure:
B.A./B.S. OR 2 years relevant experience
Other:
Bi-lingual preferred
Organized, detail driven and a self-starter.
Strong analytic, quantitative, and problem-solving skills.
Strong verbal and written communication skills.
Relationship-builder and team-player
Strong presentation skills and ability to address diverse audiences appropriately and effectively.
Computer Skills: Proficient user in MS office suite (Word, Excel and PowerPoint). 80% or more travel by car routinely required (In assigned market). Travel by plane required as needed. Maintenance of reliable means of transportation and valid driver's license and automobile insurance required.
Extended works hours, as needed. Remote work on approval.
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 sit; use hands to finger, handle, or feel and talk or hear. The employee is frequently required to reach with hands and arms. The employee is occasionally required to stand; walk; climb or balance and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
Pay Range: $54,434.00 - $81,651.00
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 ******************.
$54.4k-81.7k yearly Auto-Apply 12d ago
Senior Manager, Provider Contracting | El Paso, Texas (Remote/Home-Based)
Alignment Healthcare 4.7
Remote
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 Sr. Manager, Network Management is responsible for contracting with all provider types and successful provider network performance related to key financial, operational, and member satisfaction performance indicators in a multi-market territory. Works closely with Network Management and other departments to enhance the contracted provider experience consistent with company's mission statement and values.
General Duties/Responsibilities (May include but are not limited to):
Collaborate with Network Management leadership in the development and execution of the contracting strategy.
Recruit providers to eliminate network deficiencies within a specific region.
Negotiate / re-negotiate and finalize all contracts which may be primary care, specialist, ancillary, hospital, group/IPA as well as ensure the accuracy of administration of these agreements.
Manage staff; lead, mentor and coach staff effectively
Assure the day-to-day operations of the provider network are consistent with standards/ expectations and develops provider education materials as needed to support adherence with company requirements.
Develop agendas and lead Joint Operations Meetings to drive results, including oversight of New Provider Orientations and new Contract Orientations. Meetings will focus on addressing performance improvement metrics, resolving operational issues, including but not limited to utilization management, financial, enrollment, member appeals and grievances, provider termination/panel closures, continuity of care, and marketing activities.
Responsible for the execution of regional work-plans, monitoring performance metrics, updating status, and communicating progress both internally and externally to ensure results.
Responsible for timely and professional interaction with internal and external customers.
Ensure accurate and timely data reporting requirements are being met for designated regions, including but not limited to provider network contacts, eligibility and capitation reports, risk sharing, claims timeliness, pharmacy utilization, bed day utilization, encounter data and audit compliance.
Develop goals and objectives that align with Network Management leadership's performance metrics to ensure department KPIs are met, as well as the organization's vision for future growth and network development.
Utilize contracting knowledge for effective problem resolution and compliance. Responsible for timely and professional interaction in response to grievances. Research, analyze and resolve complex problems dealing with hospital shared risk pool, claims, appeals, and eligibility issues within the appropriate limits.
Create and implement policies and procedures for the department. Interpret company policies and procedures.
Represents the department in interdepartmental meetings and selected committees.
Other projects and responsibilities as assigned
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 disciplining employees. Will also oversee third-party vendors and/or student workers as appropriate.
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:
Minimum 5-7 years' experience with an HMO, managed care provider organization (IPA, Medical Group or institutional provider) or insurance company with at least 5 years' specific experience in managed care contracting and knowledge or Medicare Advantage regulatory guidelines.
Previous supervisory experience; demonstrated abilities to manage staff
Education/Licensure:
Bachelor's Degree or equivalent experience required
Other:
Proficient in MS Office, including strong Word and Excel proficiency.
Detail oriented.
Language Skills: Ability to read and interpret documents such as contracts, safety rules, operating and maintenance instructions and procedure manuals. Ability to interpret government regulations a must. Ability to write routine reports and correspondence.
Ability to speak effectively before groups of providers or employees of internal/external organization.
Mathematical Skills: Ability to calculate figures and amounts such as fee schedules, per diem rates, discounts, interest, commissions, proportions, and percentages. Ability to apply concepts of algebra, geometry and statistics.
Reasoning Skills: Strong analytic and problem-solving skills required, including ability to synthesize, interpret and apply detailed and complex information.
Office Hours: Monday-Friday, 8am to 5pm. Extended work hours, as needed.
Maintain reliable means of transportation. If driving, must have a valid driver's license and automobile insurance.
Drives approximately 20-40% of the time to provider sites.
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
******************
.
Pay Range: $91,651.00 - $137,477.00
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 ******************.
$91.7k-137.5k yearly Auto-Apply 51d ago
San Diego County Field Remote Nurse Practitioner or Physician Assistant (Must be able to conduct home visits in San Diego County)
Alignment Healthcare 4.7
San Diego, CA jobs
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 Advanced Practice Clinician in 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.
Responsibilities:
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:
• Required: None
• 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
Specialized Skills:
• Required:
Ability to communicate positively, professionally and effectively with others.
Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
Licensure:
• Required: Active Nurse Practitioner or Physician Assistant license
Active RN 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 11d ago
Manager, Large Group Underwriting
Healthpartners 4.2
Remote
HealthPartners is hiring a Manager of Large Group Underwriting. This leader directs the determination of rates, approval and renewal process for all group products. Establishes requirements for group composition, contribution, and eligibility provisions. The Manager of Large Group Underwriting works in the development of new group products and market strategies to attract and retain business that ensures the financial success of HealthPartners.
ACCOUNTABILITIES:
Responsible for the supervision of staff, including having the authority to hire, transfer, lay off, promote, discipline and discharge, train, reward and review performance of employees. Ensures compliance to organizational and departmental policies and procedures.
Establishes and maintains written HMO Standard, choice, self-funded medical and dental group underwriting rules, including “field underwriting” rules and procedures for initial consideration of new groups and renewal of inforce groups.
Manages the process whereby groups are initially considered as purchasers of our products.
Establishes and implements rules for assessing group composition, contribution levels, eligibility and other underwriting criteria for renewal of all group products to protect the company's financial interests and to ensure the profitability of these product lines.
Provides specific guidance to the Marketing, Sales and retention staff regarding the necessary rating and underwriting information which they must supply to determine rating and coverage strategies and methodologies for existing groups and potential new business.
Implements simultaneous offerings of multiple GHI products to maximize membership growth and minimize loss of profitability in existing groups. Directs the systems which control the release of (and contingencies for) group quotes.
Directs work objectives with other departments (I.S., Finance and others) to provide up-to-date information on the current and projected profitability of each product line.
Provides technical field support to the Sales and retention staff in the acquisition and retention of all group business. Presents to large external customers on Group Health's rating methodologies and underwriting philosophies. (Benefit Managers, consulting firms, brokerages, and other key business leaders).
Consults with Marketing and Sales Management Team in developing specific sales strategies for prospective and renewal group business.
Develops and proposes alternate funding and rating methodologies, strategies and tactics which are consistent with senior management objectives for the purpose of enhancing the marketability and profitability of GHI products.
Estimates the value and impact of proposed and legally required eligibility and administrative changes in all group coverage. Provides guidance and assistance in their implementation.
Actively participates in the creation, update and ongoing testing of business continuity and disaster recovery planning and preparation.
REQUIRED QUALIFICATIONS:
(Minimum qualifications needed for this position)
A Bachelor's Degree in a related field.
Ten or more years previous experience in underwriting group health coverage with direct responsibility for financial results and strategic planning.
Excellent oral and written communications ability.
Relevant math skills and computer experience.
Minimum of two years experience managing appropriate work group.
PREFERRED QUALIFICATIONS:
A Master's Degree or a professional benefits or insurance certification HMO or PPO experience.
DECISION MAKING:
This position requires decisions be made quickly and decisively, especially as it pertains to responding to questions from outside consultants, brokers and actuaries. Numerical interpretation as well as understanding the need of the customer are crucial for decisions which yield the desired effect for both GHI and the client.
Underwriting and pricing authority on groups of up to 1,000 contracts and annual premiums per group to approximately $3,000,000.
$71k-94k yearly est. Auto-Apply 48d ago
Registered Nurse, Operating Room
Healthpartners 4.2
Remote
Join our team as an Operating Room Registered Nurse! Our team gets to work with a variety of cases allowing you to gain a wide range of skills within the Operating Room. Regions Hospital has 21 operating rooms which includes a hybrid OR and two (2) da Vinci Xi robots. We are a busy OR with over 14,000 surgical procedures performed annually.
Under the direction of the Nurse Manager, this position is accountable for the following:
• Oversees nursing care needs of the newborn, pediatric, adolescent, adult, and geriatric patients in the Operating Room
• Implements nursing activities for operating room services and ensures compliance with all standard policies and procedures
• Assists in operating procedures and implements nursing activities for cost effective and efficient operations in an operating room
• Provides suggestions for optimizing existing work processes and resource allocation for an effective operating room
• Ensures adherence to relevant policies and procedures for operating room nursing services
• Promotes and ensures patient satisfaction with surgery and nursing care services
• Performs other duties as assigned
Work Schedule:
This is a 0.8 FTE (64 hours per pay period). Shifts will be a mix of days (6:45a-3:00p) and evenings (3:00p-11p). Occasional Overnight (11p-7a) coverage, weekly call shift coverage, with weekend responsibilities every 8th Weekend. Holiday and vacation per seniority.
Required Education & Certifications:
• Completion of a baccalaureate program in nursing
O Applicants with an associate's degree in nursing must have 1 year (2080 hours) experience as a registered nurse
• Licensed Registered Nurse with Perioperative course or completion of a perioperative clinical rotation through a nursing program OR 1 year of operating room RN experience OR licensed registered nurse with 3 years of experience as a Surgical Technologist/Surgical Assistant/Instrument Processing Technician
• Licensed registered nurse by State of Minnesota
• Basic Life Support for Health Care Providers
Benefits:
Our benefits include medical insurance, dental insurance, 401k with match, disability insurance, and tuition reimbursement. Benefits take effect first day of employment. We offer an on-site employee fitness center, an on-site physical therapy clinic for employees as well as an on-site employee clinic to make it more convenient for our staff to get the care they need. We also have a Center for Employee Resilience that provides support and evidence-based practices to bring relief and build resiliency.
Regions is a qualified non-profit employer under the federal Public Service Loan Forgiveness program. Regions is also proud to be a Yellow Ribbon Company.
$62k-83k yearly est. Auto-Apply 18d ago
Licensed Social Worker - Inpatient Hospice Discharge Coordinator
Healthpartners 4.2
Remote
Park Nicollet is looking to hire a Licensed Social Worker, (LISW or LICSW), to join our Hospice team! Come join us as a Partner for Good and help us make an impact on the care and experience that our patients and their families receive every day.
Position Summary:
Provides supportive services to help meet the patient/family social, emotional, economic, and environment needs in relation to the impact of a chronic, acute, or terminal illness though education, support/counseling, and referrals/coordination of community resources.
Completes timely visits to meet patient/family needs and ensure program compliance.
Collaborates with the interdisciplinary team to provide whole person care addressing bio-psycho-social needs of patients and family.
Provide patients/families with the psychosocial support needed to cope with chronic, acute or terminal illness through education, support/counseling and referrals for community resources.
Work Schedule: Wed - Fri 8am-4:30pm. Rotating weekend responsibilities ~q4-5 weeks.
Required Qualifications:
Education, Experience or Equivalent Combination:
Master's degree in social work
Licensure/ Registration/ Certification:
Education, Experience or Equivalent Combination:
Master's degree in social work
Licensure/ Registration/ Certification:
Must have Minnesota (MN) Social Work license upon start date:
Licensed Independent Social Worker (LISW) or
Licensed Independent Clinical Social Worker (LICSW)
Must have vehicle, driver's license and current auto insurance. Must meet all criteria required under Park Nicollet's Automobile Liability Guidelines
Knowledge, Skills, and Abilities:
Strong psychosocial assessment skills and implementation of interventions based on Social Work assessment.
General Roles
Ability to function independently with minimal supervision.
Experience and comfort providing services in the community, including patient homes.
Knowledge of reimbursement procedures as well as knowledge of community resources.
Ability to function effectively on an interdisciplinary team.
Ability to effectively communicate in written and verbal form within the interdisciplinary team.
Ability to independently carry out directions and follow medical orders for services.
Computer experience including documentation in an electronic medical record.
Comfort or experience working within serious illness or end of life.
Ability to adapt to a flexible and changing schedule to meet patient needs.
Willing to participate in a rotating schedule including weekends.
Preferred Qualifications:
Education, Experience or Equivalent Combination:
Master's degree in social work
Licensure/ Registration/ Certification:
MN licensure at the LICSW level.
Knowledge, Skills, and Abilities:
Previous Hospice experience
Advance Care Planning experience
Experience with facilitation of goals of care conversations.
Benefits:
Park Nicollet offers a competitive benefits package (for eligible positions) that includes medical insurance, dental insurance, a retirement program, time away from work, insurance options, tuition reimbursement, an employee assistance program, onsite clinic and much more!
$61k-75k yearly est. Auto-Apply 60d ago
Surgical Technologist, Operating Room
Healthpartners 4.2
Remote
Join our Operating Room team as a Surgical Technologist in a Level I Trauma Center! The Surgical Technologist functions as an active member of the surgical team in the role of the scrub person. This includes assisting the Circulator with the preparation of the O.R. suite by reviewing the preference card for the appropriate supplies, assists with the gathering of equipment and instrumentation, practices department procedures for hand scrub, gowning and gloving, accurately prepares drugs under the supervision of the Registered Nurse Circulator, sets up sterile instruments, suture and all sterile supplies and maintains sterile field of instruments and supplies during procedures. The Surgical Technologist anticipates and communicates the surgeon's needs and has instruments & supplies readily available for use.
New grads welcomed and encouraged to apply!
Work Schedule:
This is a 0.8 FTE (64 hours every two weeks). Work schedule will be a mix of day (7:00 am - 3:00 pm) and evening (3:00 pm - 11:00 pm) shifts, and occasional overnight (11:00 pm -7:00 am). There are also weekend responsibilities approximately every 8th weekend. Holiday and vacation rotations per seniority.
Minimum Qualifications:
Completion of a surgical technologist training program
Completion of national certification exam offered by the National Board of Surgical Technology and Surgical Assisting (NBSTSA), or National Center for Competency Testing (NCCT) within 12 months of hire date. Certification to be maintained by employee during length of employment.
CPR certification required at time of employment and every two years thereafter
Benefits:
Our benefits include medical insurance, dental insurance, 401k with match, disability insurance, and tuition reimbursement. Benefits take effect first day of employment. We offer an on-site employee fitness center, an on-site physical therapy clinic for employees as well as an on-site employee clinic to make it more convenient for our staff to get the care they need. We also have a Center for Employee Resilience that provides support and evidence-based practices to bring relief and build resiliency.
Regions is a qualified non-profit employer under the federal Public Service Loan Forgiveness program. Regions is also proud to be a Yellow Ribbon Company.
$45k-58k yearly est. Auto-Apply 60d+ ago
Licensed Practical Nurse- Home Based Medicine
Healthpartners 4.2
Bloomington, MN jobs
Park Nicollet is looking to hire an LPN to join our Home-Based Medicine and In Home Complex Care team! Come join us as a Partner for Good and help us make an impact on the care and experience that our patients and their families receive every day.
Position Summary:
Provides practical nursing care to patients in accordance with the Minnesota Nurse Practice Act, recognized professional standards and PNHS policy. Provides safe and effective nursing care by promoting a safe, therapeutic environment and by advocating for the best interests of individual patients. Supports multiple areas within a clinic setting with strong interpersonal skill and flexibility while maintaining patient confidentiality and protecting patient rights.
This role will support our home-based medicine team, an exciting and innovative approach to providing primary care in the home. This role will provide both telephonic and in person support (home visits) to patients in partnership with clinicians, RNs, social workers and care managers.
Work Schedule:
Monday-Friday, daytime hours
40 hours per week.
Required Qualifications:
Graduate from an accredited school of practical nursing.
Must maintain a current state license of practical nursing.
Current BLS certification for health professionals through the American Heart Association or American Red Cross required and maintained.
On-line BLS certification is not acceptable.
Preferred Qualifications:
One or more years of healthcare experience is desirable (preferably in a related field of medicine).
Benefits:
Park Nicollet offers a competitive benefits package (for eligible positions) that includes medical insurance, dental insurance, a retirement program, time away from work, insurance options, tuition reimbursement, an employee assistance program, onsite clinic and much more!
$38k-48k yearly est. Auto-Apply 22d ago
Identity and Access Management (IAM) Analyst
Healthpartners 4.2
Bloomington, MN jobs
HealthPartners is hiring for an Identity and Access Management (IAM) Analyst. The Analyst plays a critical role in safeguarding access across the organization. This position collaborates with business leaders and IT application managers to design and implement secure, efficient identity and access solutions. The analyst is responsible for analyzing business needs and translating them into streamlined security administration processes, automating, and optimizing access provisioning using SailPoint workflows, and ensuring timely and accurate administration of user identities, authentication, and authorization. The role supports hundreds of applications by driving automation and improving efficiency, making this expertise essential to delivering secure, seamless access for the workforce. The analyst reports to the Manager, Identity and Access Management and collaborates with a dedicated team focused on enterprise security and access solutions.
Required Qualifications:
Bachelor's degree in Information Technology, Business, or related field OR equivalent work experience
Two (2) years' experience as an IT analyst or performing analytical functions.
One (1) year of IT security management, operations, or administration experience
Experience with SailPoint
Experience with Windows and Unix Security Administration Menus
Exposure to enterprise-level Identity and Access Management solutions
Outstanding customer service skills
Proven problem solving and analytical skills.
Excellent oral and written communication skills
Working knowledge of MS Active Directory, Exchange, DNS, DHCP, TCP/IP
Experience in integrating IAM solutions.
Preferred Qualifications:
Previous experience with SailPoint Identity Security Cloud (ISC)
Two (2) years' experience working with Identity and Access Management tools.
Project Coordination and/or Project Management experience
Hours/Location:
Monday - Friday; core business hours
Work can currently be performed remotely; however, will need to be onsite on Tuesdays and Thursdays to help jump-start project work. There is also an on-call rotation, with each team member scheduled for one week approximately every five weeks.
Responsibilities:
Provides efficient administration of user access to those systems maintained by the IT security administration group.
Coordinates across Business Partners and Information Technology Application Groups to identify access requirements and assists in integrating these requirements into Security Administration tools and processes.
Analyzes Security Administration processes / workflows, recommends ways to improve efficiency and effectiveness and helps implement the solutions.
Establishes and analyzes identities, roles, and access assignment - Develops and maintains Role Based Access Controls (RBAC)
Supports and implements access management tools; ensuring incident investigation and ensuring resolution.
Reviews, develops, and maintains security administration processes and procedures.
Evaluates Identity Access Management (IAM) solutions and assists in implementation of such solutions.
Configures, analyses, and maintains IAM tool ensuring high efficiency and effectiveness of the tool.
Coordinates timely incident and problem resolution with vendors.
Recommends, analyzes, and supports integration of additional systems/applications to IAM.
Recommends, analyzes, and supports integration of additional systems/applications to Active Directory - LDAP
Ensures that HealthPartners access management aligns with IT's security policies and standards.
Obtains and reports on key metrics for security administration operational effectiveness.
Assists with automation of tasks to reduce manual and repetitive work. May include writing or configuring simple scripts.
Creates awareness of security policy and security administration best practices; guiding access and reporting needs to accommodate best security practices.
Performs other duties as assigned.
$62k-83k yearly est. Auto-Apply 60d+ ago
Speech Language Pathologist
1St. Choice Visiting Nurses LLC 4.1
Kissimmee, FL jobs
Job DescriptionJob Title: Pediatric Speech-Language Pathologist (SLP) Teletherapy (Remote) Job Type: Contract Per Diem (Flexible) $70.00 for evals Were looking for a dedicated and compassionate Speech-Language Pathologist (SLP) with a passion for working with children to join our pediatric teletherapy team! In this fully remote position, youll provide engaging, evidence-based speech and language therapy to children ages 0-21 via a secure online platform.
This is a great opportunity for clinicians seeking flexible scheduling, reduced commute stress, and a meaningful way to help kids thriveright from home.
What Youll Do:
Deliver speech and language therapy sessions virtually to pediatric clients
Conduct evaluations and re-evaluations
Develop and implement individualized treatment plans and IEP goals
Collaborate with families and caregivers
Track and document progress using digital tools
Create fun, engaging, and age-appropriate therapy experiences online
What Youll Need:
Masters degree in Speech-Language Pathology
Active state license as an SLP
ASHA CCC-SLP certification
Minimum 1 year of pediatric clinical experience
Teletherapy experience is required
Strong communication, tech skills, and a love for working with kids
Own a reliable personal computer
Working knowledge of technology, such as headphones and personal computers
This is a remote position.