Telligen jobs - 39 jobs

This senior-level position provides strategic leadership for internal and external communications implementing client program efforts and executing integrated marketing and communication initiatives. Primary accountabilities include achieving the intent of the program deliverables and objectives by understanding the requirements and tailoring work to meet those needs while protecting the company's brands. Demonstrate strong strategic communication and problem-solving skills with clients, peers, management, and program staff.Essential Functions You will lead and mentor marketing/communications team members. You will develop and implement comprehensive marketing and communication strategies for select client programs. You will establish and maintain relationships with senior stakeholders, both internal and external. You will collaborate with workgroups and key staff members to define marketing and communication needs in order to develop integrated solutions. You will provide strategic counsel to program leadership on communication approaches. You will manage deliverable schedules for projects that include graphics, website design and functionality, white papers, newsletters, presentations, collateral and other communication activities, outreach, and analysis. You will lead all internal and external communications functions to ensure consistent, cohesive, and effective messaging that fulfills the communications and branding requirements of the program. You will create presentations for various meetings, conferences and events. You will create and lead development of promotional materials such as brochures, newsletters, collateral materials and white papers. You will lead development of regular communications to clients, prospects, stakeholders and other audiences including newsletters, and other electronic forms of communication. You will establish program-wide processes and standards for communications. You will oversee multiple concurrent projects and initiatives. You will implement quality control processes across all communication channels. You will develop and track program-level metrics and KPIs. You will resolve complex issues and remove barriers to success. You will ensure communication materials comply with company, customer and regulatory standards by implementing editorial standards for communication content. Requirements Four-year degree in business, journalism, marketing or communications related field (Master's preferred) 7-10 years experience in marketing and/or communications; demonstrated experience with web-based marketing and/or communications; demonstrated experience with marketing collateral, websites, social media, newsletters and press releases; 3-5 years of team leadership experience. Strong portfolio of strategic communications initiatives. Healthcare industry experience preferred. Who We Are: Telligen is one of the most respected population health management organizations in the country. We work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise. Over our 50-year history, health care has evolved - and so have we. What hasn't changed is our deep commitment to those we serve. Our success is built on our ability to adapt, respond to client needs and deliver innovative, mission-driven solutions. Our business is our people and we're seeking talented individuals who share our passion and are ready to take ownership, make an impact and help shape the future of health. Are you Ready? We're on a mission to transform lives and economies by improving health. Ownership: As a 100% employee-owned company, our employee-owners drive our business and share in our success.Community: We show up - for our clients, our communities and each other. Being a responsible corporate partner is part of who we are.Ingenuity: We value bold ideas and calculated risks. Innovation thrives when we challenge the status quo and listen to diverse perspectives.Integrity: We foster a respectful, inclusive, and collaborative environment built on trust and excellence. Thank you for your interest in Telligen!Follow us on Twitter, Facebook, and LinkedIn to learn more about our mission-driven culture and stay up to speed. While we use artificial intelligence tools to enhance our initial screening process, all applications are thoroughly reviewed by our human recruitment team to ensure a fair and comprehensive evaluation of each candidate. Telligen and our affiliates are Equal Opportunity Employers and E-Verify Participants. Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. We will not accept 3rd party solicitations from outside staffing firms.

Opportunity Information Sutter Medical Group (SMG) seeks to hire a BE/BC fellowship-trained Body Imaging Radiologist to join an established practice in Jackson, CA. Sutter Imaging is seeking a fellowship-trained imager and to join our close-knit, quality care-centered group within a larger, financially strong, and stable organization. We are seeking a candidate who enjoys the flexibility to work from home and working on-site including diagnostics and IR. This role offers a dynamic work environment with moderate volumes and opportunities for professional growth. The schedule is flexible to allow a good work/life balance. Weekend, STAT, & Flex shifts are available to read from home for anyone wishing to expand income beyond their base salary. Qualifications Board certified/Board eligible Join Us and Enjoy PLSF eligible Subspecialty-structured radiology group with advanced practice technology $600,000 Base compensation with opportunities to earn additional income through flex shifts* $50k sign-on bonus (paid in 2 parts) Assistance with relocation expenses Generous benefits, including employer-matched 401(k) and profit-sharing Shareholder track CME allowance Equitable practice and scheduling structure A positive work-life balance and Northern California's natural beauty and lifestyle 10 weeks scheduled vacation 4-day average work week Holidays are shared equitably Ability to work some shifts from home (Weekend, STAT, & Flex Shifts) Organization Details Sutter Medical Group is a successful, 1,500+ member multi-specialty group offering physicians the opportunity to build their practices within a progressive, financially sound, and collaborative organization. SMG is recognized as a Top Performing Physician Group by the Integrated Healthcare Association. Our members are dedicated to providing the highest quality and most complete health care possible to the people in the communities we serve in the greater Sacramento Valley Area of Amador, Placer, Sacramento, Solano, and Yolo Counties. Community Information Jackson, CA is a charming historic town nestled in the Sierra Nevada foothills, known for its Gold Rush heritage and small-town appeal. The downtown area features preserved 19th-century architecture, boutique shops, and local wineries that reflect the region's rich past. Surrounded by scenic rolling hills and outdoor recreation, it's a gateway to hiking, fishing, and exploring California's wine country. Jackson offers a peaceful lifestyle with a strong sense of community, just an hour southeast of Sacramento. Equal Opportunity Statement It is the policy of Sutter Health and its partners to provide equal employment for all qualified individuals; to prohibit discrimination in employment because of basis of race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state or federal law, ordinance or regulation. We promote the full realization of equal employment opportunities through a positive continuing program within each medical group, company, hospital, department, and service area. Equal employment opportunities apply to every aspect of Sutter's employment policies and practices.

iMPROve Health is seeking a Orthopedic Spine Physician to serve as an independent contractor (1099) performing independent external medical reviews remotely on an ad hoc basis. As a peer reviewer, you will apply your clinical expertise to evaluate cases, specific to your specialty, medical necessity and/or standard of care, supporting efforts to enhance the overall quality and integrity of health care and your profession. Please note, this is not an employed position and our contracted fee is based on credential and specialty type. BENEFITS: * Make a Difference: Use your clinical knowledge to improve the quality of care patients receive. * Professional Recognition: Join a network of highly respected experts in your specialty. * Competitive Compensation: Receive fair pay for your time and expertise. * Protect Standards of Care: Help uphold the integrity of your profession. * Work Remotely: Review cases from the convenience of your home or office. DUTIES AND RESPONSIBILITIES: * Conduct objective, evidence-based peer reviews of clinical cases. * Make final determinations regarding medical necessity and quality of care. * Ensure decisions are fair, unbiased, and aligned with current standards of practice. * Submit reviews in a timely and professional manner using the IT systems provided. QUALIFICATIONS: * Medical License: Must hold an unrestricted medical license in any U.S. state. * Board Certification:Required (if applicable), through a board recognized by: * The American Board of Medical Specialties (ABMS), * The American Osteopathic Association (AOA), or * Another nationally recognized board granting certification. * Clinical Experience: * Have at least five (5) years full-time equivalent experience providing direct clinical care to patients. * Have experience providing direct clinical care to patients within the past three (3) years. * Knowledgeable of the issue under review, or of the current, evidence-based clinical guidelines and novel treatments for the medical or behavioral health condition, disease, treatment, or procedure under review. * Have the clinical expertise to manage the medical or behavioral health condition or disease under review. * Must be actively engaged in direct or virtual patient care for at least 20 hours per week. Administrative work does not qualify. TECHNOLOGY REQUIREMENTS: * Reliable Wi-Fi access. * Proficiency with Microsoft Word. * Access to a computer compatible with iMPROve Health's IT systems. OTHER REQUIREMENTS: * Must complete the electronic credentialing application and receive organizational approval prior to performing a case review. * Must complete a conflict of interest attestation upon credentialing and prior to performing a case review. * Active hospital medical staff privileges may be required, as applicable. * Notify the organization in a timely manner of an adverse change in licensure or certification status, including board certification status. * Cannot have current employment or affiliation with any Veterans Affairs (VA) hospital, health care system, or medical center if applying to perform VA-related peer reviews. EOE/VET/Disability

**This is a mobile position which will work primarily out in the assigned communities.** Join a Mission That Moves With You: Mobile/Remote Care Management across NC Why You'll Love Working Here In 2026, the future of healthcare is in the community. As an I/DD Care Manager at Partners, you aren't just managing files-you are the architect of a better life for individuals with Intellectual and Developmental Disabilities. We offer a role that balances clinical excellence with geographic flexibility , supported by one of the most stable and competitive benefits packages in North Carolina. The Perks of Joining Our Team: Work Where You Live: Fully mobile/remote role serving the counties you live in, work in and call home. Financial Security: State Retirement Pension plan, 401(k) with employer match, company paid life and disability insurance, and an annual incentive bonus. Health & Wellness: Low-deductible medical/dental plans and generous vacation + sick time accruals. Student Loan Relief: We are a Public Service Loan Forgiveness (PSLF) Qualifying Employer -let your work pay off your education. Celebrate Life: 12 paid holidays and dedicated wellness programs. See attachment for additional details. Location: Available for Gaston, Cleveland, Rutherford NC locations; Mobile/Remote position Projected Hiring Range: Depending on Experience Closing Date: Open Until Filled Your Impact & Role As a Partners Care Manager, you will serve as the primary point of contact and navigator for members with I/DD and/or dually diagnosed members. You will lead "Team Based Care," ensuring our members receive holistic support that integrates physical health, behavioral health, and long-term supports and services. What a Typical Week Looks Like: Meet Members Where They Are: Meet members in their communities to assess their current and projected needs to build Person-Centered Care Plans/Individual Support Plans (ISP) to get them closer to achieving their vision for their lives. Integrative Leadership: Facilitate interdisciplinary team meetings to ensure doctors, specialists, providers and families are all moving in the same direction to meet the member's needs. Transition Expert: Guide members through life's big changes-moving from school to adulthood, returning home from care facilities, gaining optimal independence and finding the right combination of paid supports to maintain or increase overall health and wellness. Empowerment: Educate members and families on their rights and connect them to the array of services and our network of providers to secure their future. Who You Are A Mobile Professional: A North Carolina resident and you thrive on the road and value the autonomy of a community-based role. Travel is an essential part of how you connect with those you serve. A Systems Navigator: You understand (or are eager to master) Medicaid regulations, 1915i services, and the Tailored Plan landscape. A Person-Centered Planner: You believe there is no "one size fits all" solution in care management. You bring a voice to vulnerable individuals through your strengths of observation, connecting the dots, supporting their journey through your planning skills. Qualified Candidate to apply : You've earned your degree and put it to work! Congratulations! You are who we are looking for if one of these many different scenarios describe you… You have earned a Bachelor's degree in a human services field like psychology, social work, nursing or other relevant human services field: and you bring with you a minimum of 2 years full-time experience working with individuals with Intellectual and Developmental Disabilities and at least 2 years of your work experience was with people with significant Long-Term Services and Supports (LTSS) needs due to their disability in a setting where they receive care in the community OR You earned a Bachelor's degree outside the human services field and you have at least 4 years full-time experience working with individuals with Intellectual and Developmental Disabilities. and at least 2 years of your work experience was with people with significant Long-Term Services and Supports (LTSS) needs due to their disability in a setting where they receive care in the community OR You earned a Master's degree and have a minimum of 1 year full time experience working with individuals with Intellectual and Developmental Disabilities and at least 2 years of your work experience was with people with significant Long-Term Services and Supports (LTSS) needs due to their disability in a setting where they receive care in the community

Opportunity Information Gould Medical Group is seeking a per diem, BE/BC remote Radiologist for established and collegial radiology team in Modesto, California. Must be resident of CA and have CA medical license $362.99 per hour Malpractice insurance provided Non-benefited W2 employee position Outpatient only No call required No procedures required Support from other radiologists onsite and remote Modalities: PF, US, CT, MRI, ultrasound Epic/Visage PACS Nuance PowerScribe dictation Qualifications Board certified/Board eligible Organization Details Gould Medical Group is a growing, 525+ clinician multi-specialty group located about two hours east of San Francisco, California. Equal Opportunity Statement It is the policy of Sutter Health and its partners to provide equal employment for all qualified individuals; to prohibit discrimination in employment because of basis of race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state or federal law, ordinance or regulation. We promote the full realization of equal employment opportunities through a positive continuing program within each medical group, company, hospital, department, and service area. Equal employment opportunities apply to every aspect of Sutter's employment policies and practices.

The Health Informatics (HI) Solution Coordinator at Telligen is a specialized technical support role focused on managing and supporting the Qualitrac application for various Medicaid and Commercial contracts. As a Qualitrac platform subject matter expert, responsibilities include providing operational support, maintaining documentation and user guides, conducting product validation, and developing process materials. Success in this desk-based position requires proficiency in Microsoft Office, strong problem-solving capabilities, and exceptional customer service skills, with prior Qualitrac experience being highly valuable. The role demands meticulous attention to detail, excellent communication abilities, and proven capability to manage multiple priorities while thriving in a collaborative team environment.Essential Functions You will serve as subject matter information resource to internal and external customers. Utilize knowledge to research and resolve issues in a timely manner and to the customer's satisfaction. You will create and update multiple formats of documentation, ensuring information is accurate, thorough, and follows established processes and compliance requirements (i.e. 508 compliance standards). You will provide product level validation to identify issues and recommend changes if needed. You will provide input based on subject, program and product knowledge to the business and functional requirements for software products and services, including enhancements. Complete tickets and deliverables on time. You will perform other duties as assigned. Requirements Four-year degree in business, healthcare, or IT 1-3 years of relevant experience, or comparable work experience in application support and troubleshooting Proven ability to excel in a fast-paced environment while managing concurrent priorities and meeting critical deadlines Strong collaborative mindset with demonstrated success in cross-functional team environments Exceptional analytical and problem-solving capabilities with a solutions-oriented approach Track record of identifying and implementing process improvements through systematic analysis Advanced proficiency in enterprise software systems and technical troubleshooting Strong organizational and time management abilities Excellent interpersonal skills with emphasis on team collaboration Demonstrated capacity for complex problem resolution and strategic thinking Working knowledge of Qualitrac systems preferred OR candidate must possess strong technical competencies and demonstrate ability to quickly master industry-specific software applications. Who We Are: Telligen is one of the most respected population health management organizations in the country. We work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise. Over our 50-year history, health care has evolved - and so have we. What hasn't changed is our deep commitment to those we serve. Our success is built on our ability to adapt, respond to client needs and deliver innovative, mission-driven solutions. Our business is our people and we're seeking talented individuals who share our passion and are ready to take ownership, make an impact and help shape the future of health. Are you Ready? We're on a mission to transform lives and economies by improving health. Ownership: As a 100% employee-owned company, our employee-owners drive our business and share in our success.Community: We show up - for our clients, our communities and each other. Being a responsible corporate partner is part of who we are.Ingenuity: We value bold ideas and calculated risks. Innovation thrives when we challenge the status quo and listen to diverse perspectives.Integrity: We foster a respectful, inclusive, and collaborative environment built on trust and excellence. Thank you for your interest in Telligen!Follow us on Twitter, Facebook, and LinkedIn to learn more about our mission-driven culture and stay up to speed. While we use artificial intelligence tools to enhance our initial screening process, all applications are thoroughly reviewed by our human recruitment team to ensure a fair and comprehensive evaluation of each candidate. Telligen and our affiliates are Equal Opportunity Employers and E-Verify Participants. Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. We will not accept 3rd party solicitations from outside staffing firms.

- not eligible for benefits Projected Hiring Range: Depending on Experience Primary Purpose of Position: This position provides the initial screening, referral and or scheduling of members who call the toll-free PartnersACCESS Member Services number seeking health and behavioral health services and as appropriate, transfers the member to a clinician who will clinically triage/assess the member's acuity and will determine what type and intensity of service the member needs and/or is eligible to receive. Role and Responsibilities: Screening, scheduling and referral: Initial screening of Health/Mental Health (MH)/Substance Use (SU)/Traumatic Brain Injury (TBI)/Intellectual/Developmental Disability (I/DD) treatment needs, benefit information and referral of members calling to determine if they may potentially qualify for services Collect and enter demographic data into the electronic record, completion of appropriate forms, explanation of services, benefits and resources, verifies Medicaid and dispatch Provide follow up calls to referral sources and members to ensure that members have been successfully engaged in services Make referrals to clinical homes and crisis providers that meet the timeliness standards as defined by NC Medicaid Provide information about local community resources, independent practitioners, and related providers for referrals for basic benefit services This position demands a high level of accuracy and confidentiality. Information must be handled according to NC standards and rules, state and federal laws and LME/MCO and NCQA standards, procedures, policies and protocol Authorizations: Assists with authorizations/admissions to state hospitals, ADATC, Three Way Hospitals, Level III Detox, Facility Based Crisis and all referrals to crisis services Process other acute care authorizations as requested by supervisor or other Access to Care Licensed Clinician Automation: Screenings are completed using standard and specialized computer programs Inputs accurate information into the system and unlocks electronic service records with appropriate consents, enters all necessary data elements into data systems Provide technical assistance to First Responders, clinical home providers, and Mobile Crisis Management Cooperative Efforts: Establish and maintain effective working relationships within the unit, agency, and service system Consistently demonstrate professionalism, tact and diplomacy in handling irate callers and/or working with contract providers and other external parties Participate in Unit Staff meeting, Agency Staff meetings, (All staff meetings) and assigned committees Knowledge, Skills and Abilities: Sound knowledge of health/MH/SU/TBI/I/DD for the appropriate determination of eligibility for Medicaid and State supported services, appropriateness of referrals for treatment and assessment and the level of danger of the members calling for assistance Knowledge of the laws governing the treatment of health, mental illness, substance abuse and intellectual/developmental disabilities as well as the resources available in the community for treatment Knowledge of call center functions, member population, potential for crisis issues, confidentiality laws and program protocols/policies Excellent computer skills Ability to complete tasks independently, define problems, apply laws, policies and procedures to agency activities and must use sound judgment in conducting screening, triage and referral Ability to use sound judgment when conducting a screening and be able to determine when it is necessary and appropriate to transfer a member to a Licensed Access to Care Clinician Ability to communicate effectively orally and in writing, have good keyboarding skills and be able to multi-task (that is: converse while entering screening information into the electronic medical record and evaluating the member's need) Ability to take highly complicated criteria and apply it to cases in determining eligibility for services and appropriate scheduling referrals Ability to assist members in highly stressful situations which may be life threatening to the member or public while at the same time facilitating a connection to crisis services and/or a Licensed Access to Care Clinician Ability to provide technical assistance to both members and Providers Ability to maintain confidentiality when screening and referring calls/callers Education/Experience Required: Bachelor's Degree in related field or Licensed Practical Nurse (LPN) and at least two (2) years of healthcare or MH/SU/IDD experience. Education/Experience Preferred: Licensed practical nurses (LPNs) and at least four (4) years of healthcare and/or MH/SU/IDD experience. Licensure/Certification Requirements: N/A

This position is responsible for providing technical and project administrative support for various contracts/customers. This position will be fully remote, but candidates must reside within the state of IowaEssential Functions You will prepare documentation to support team and create, update, and monitor timeliness of project plans. Take meeting minutes and documents action items. You will assist with writing and formatting project documents, technical papers and presentations. You will coordinate project documentation from multiple sources. Communicate with internal/external customers in a professional manner. Escalate issues through appropriate channels, following established hierarchical protocols between clinical and non-clinical staff members. You will perform support functions including scheduling onsite and off-site meetings and conference calls, answering phones, monitoring email inboxes, ordering supplies, copying and distributing correspondence. You will coordinate schedules for team members. May create a master planning calendar of contract events. Coordinates set up for new hires. Ensures files are up to date and accurate. You will monitor status of deliverables, data processing and reporting schedules. Report variations or discrepancies to management. Ensure files are up to date and accurate. Performs miscellaneous duties as assigned. Requirements Two-year degree in business, healthcare, IT or related field and/or equivalent training and/or experience 2 years of experience in project administrative support; demonstrated ability working with confidential information and in a deadline driven environment; demonstrated ability to effectively multi-task and problem solve. Because of the nature and immediacy of the work, the ability to maintain regular and predictable attendance is essential. Who We Are: Telligen is one of the most respected population health management organizations in the country. We work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise. Over our 50-year history, health care has evolved - and so have we. What hasn't changed is our deep commitment to those we serve. Our success is built on our ability to adapt, respond to client needs and deliver innovative, mission-driven solutions. Our business is our people and we're seeking talented individuals who share our passion and are ready to take ownership, make an impact and help shape the future of health. Are you Ready? We're on a mission to transform lives and economies by improving health. Ownership: As a 100% employee-owned company, our employee-owners drive our business and share in our success.Community: We show up - for our clients, our communities and each other. Being a responsible corporate partner is part of who we are.Ingenuity: We value bold ideas and calculated risks. Innovation thrives when we challenge the status quo and listen to diverse perspectives.Integrity: We foster a respectful, inclusive, and collaborative environment built on trust and excellence. Thank you for your interest in Telligen!Follow us on Twitter, Facebook, and LinkedIn to learn more about our mission-driven culture and stay up to speed. While we use artificial intelligence tools to enhance our initial screening process, all applications are thoroughly reviewed by our human recruitment team to ensure a fair and comprehensive evaluation of each candidate. Telligen and our affiliates are Equal Opportunity Employers and E-Verify Participants. Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. We will not accept 3rd party solicitations from outside staffing firms.

We are so glad you are interested in joining Sutter Health! Organization: PAMF-Palo Alto Medical Foundation CAD is eligible to work from home but must be available to go on-site as needed** Responsible for daily departmental operations, implementing standardized processes and best practices, carrying out the concept of one team, assisting in monitoring compliance with regulatory, accreditation, and safety standards. Monitors every day activities and maintains an effective working relationship with internal and external customers. Collaborates closely with referring physicians, physician office staff, physician liaisons, and all other key department managers impacted by these services. Job Description: JOB ACCOUNTABILITIES: OPERATIONS: • Plans, organizes, and directs the workflow in assigned financial areas, ensuring the quality and quantity of work produced. • Creates a culture of patient centered care and customer service, consistent with the organization's mission, values, and vision. • Responsible for supervising and assigning staff resources to ensure all registration functions are adequately staffed. • Collaborates with others to coordinate services, streamline work flow, standardize procedures, and/or drive positive outcomes. • Identifies areas of non-compliance or vulnerability, developing, recommending and implementing corrective action plans to address or minimize risk. • Keeps leadership informed of operations, and escalates complex issues requiring higher level direction. PLANNING: • Identifies ways to improve work processes, enhance quality, productivity, and service delivery. • Participates in departmental goal setting process and communicates goals to staff. • Monitors staff productivity, ensuring optimal use of resources and makes appropriate changes in response to fluctuations in workload. • Provides input to leadership chain of command on current and future needs of personnel to meet needs of clients and/or operational demands. • May prepare reports and/or analyses, identifying operational trends and recurrent issues, and recommends and implements course of action. FINANCIAL MANAGEMENT: • Assists in meeting financial targets by effectively managing and utilizing personnel and resources. • Manages and monitors staffing to minimize labor costs. • Monitors expenses and works with leadership to develop and implement corrective actions plans to address unfavorable variances. • May participate in the operating and capital budgeting process. PEOPLE: • Supervises assigned staff, makes or provides input into hiring and termination decisions, develops work schedules, and reviews and approves timekeeping records. • Sets and maintains expectations with all direct reports and holds individuals and work teams accountable. • Evaluates staff performance and recommends associated merit increase. Provides constructive feedback, coaching and counseling. Implements disciplinary actions and/or performance improvement plans to achieve desired performance. Works with leadership when major disciplinary action is necessary and, if appropriate, in consultation with Human Resources. • Provides opportunities for career development, role expansion, and cross-training. • Develops department training and orientation plans, ensuring staff meets competency requirements and participates in appropriate education and training programs. • Conducts staff meetings for informative and educational purposes. • Responds timely to alleged violations of policies, procedures, regulations and standards of conduct by evaluating or recommending the initiation of investigative procedures. EDUCATION: HS Diploma or General Education Diploma (GED) TYPICAL EXPERIENCE: 5 years of recent relevant experience. SKILLS AND KNOWLEDGE: Solid understanding of medical terminology and insurance. Familiarity with general hospital management principles, practices, and procedures. Knowledge and understanding of applicable local, state, federal and other laws, regulations and requirements impacting department operations. Leadership skills, including team building, and coaching/mentoring with the ability to motivate and engage others. Organizational and time management skills, with the ability to prioritize multiple projects while delivering quality service/achieving business results. Demonstrates ability to work in a dynamic and fast-paced environment with changing business priorities. Ability to work concurrently on a variety of tasks/projects in an environment that may have competing priorities, be high volume, and working with individuals having diverse personalities and work styles. Job Shift: Days Schedule: Full Time Days of the Week: Monday - Friday Weekend Requirements: None Benefits: Yes Unions: No Position Status: Exempt Weekly Hours: 40 Employee Status: Regular Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans. Pay Range is $43.34 to $65.00 / hour The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate's experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health's comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.

Competitive Compensation & Benefits Package! eligible for - Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan Generous vacation and sick time accrual 12 paid holidays State Retirement (pension plan) 401(k) Plan with employer match Company paid life and disability insurance Wellness Programs Public Service Loan Forgiveness Qualifying Employer See attachment for additional details. Office Location: Remote Option; Available for any of Partners' NC locations Projected Hiring Range : Depending on Experience Closing Date: Open Until Filled Primary Purpose of Position: This position is responsible for ensuring that providers receive timely and accurate payment. Role and Responsibilities: 50%: Claims Adjudication Responsible for finalizing claims processed for payment and maintaining claims adjudication workflow, reconciliation and quality control measures to meet or exceed prompt payment guidelines. Responsible for reconciling provider claims payments through quality control measures, generally accepted accounting principles and agency's policies and procedures. Assess Title XIX and non-Title XIX claims adjustments for correction or recoupment and will coordinate the recoupment process to ensure payment is recovered for inappropriately paid claims. Provide back up for other Claims Analysts as needed. 40%: Customer Service Maintain provider satisfaction by being available during regular business hours to handle provider inquiries; interacting in a professional manner; providing information and assistance; and answering incoming calls. Assist providers in resolving problem claims and system training issues. Serve as a resource for internal staff to resolve eligibility issues, authorization, overpayments, recoupments or other provider issues related to claims payment. 10%: Compliance and Quality Assurance Review internal bulletins, forms, appropriate manuals and make applicable revisions Review fee schedules to ensure compliance with established procedures and processes. Attend and participate in workshops and training sessions to improve/enhance technical competence. Knowledge, Skills and Abilities: Working knowledge of the Medicaid Waiver requirements, HCPCS, revenue codes, ICD-10, CMS 1500/UB04 coding, compliance and software requirements used to adjudicate claims General knowledge of office procedures and methods Strong organizational skills Excellent oral and written communication skills with the ability to understand oral and written instructions Excellent computer skills including use of Microsoft Office products Ability to handle large volume of work and to manage a desk with multiple priorities Ability to work in a team atmosphere and in cooperation with others and be accountable for results Ability to read printed words and numbers rapidly and accurately Ability to enter routine and repetitive batches of data from a variety of source documents within structured time schedules Ability to manage and uphold integrity and confidentiality of sensitive data Education and Experience Required: High School graduate or equivalent and three (3) years of experience in claims reimbursement in a healthcare setting; or an equivalent combination of education and experience. Education and Experience Preferred: N/A Licensure/Certification Requirements: N/A

This position focuses on Home and Community Based Services (HCBS) provider quality and will evaluate HCBS waiver, habilitation, CNRS providers, and self-directed services to ensure quality and compliance with state and federal rules and laws and industry best practice standards. The HCBS Provider Quality Specialist for applications will focus on HCBS provider applicants in Central and Western Iowa to provide a successful onboarding experience including technical assistance on the development and implementation of policies and procedures, training development, and evaluation of the provider through their initial quality oversight review. Candidate must live North/Central Iowa or Western Iowa to be considered for this opportunity Essential Functions Conduct comprehensive quality evaluations of HCBS waiver, Habilitation, CNRS providers, and self-directed services Assess provider compliance with state and federal regulations, policies, and procedures Develop and implement corrective action plans with providers Provide technical assistance and guidance to providers on HCBS topics. Document findings and maintain detailed records of provider evaluations Analyze data and prepare reports on provider performance and compliance Facilitate training sessions and educational workshops for providers Collaborate with stakeholders to implement quality improvement initiatives Monitor provider progress in meeting quality standards Stay current with evolving HCBS regulations and best practices Requirements Bachelor's degree in healthcare administration, social work, public health, or related field Minimum 3-5 years experience in HCBS or quality improvement Knowledge of state and federal HCBS regulations and requirements Understanding of quality assurance principles and methodologies Strong analytical and problem-solving skills Excellent written and verbal communication skills Proficiency in Microsoft Office Suite and able to use various types of technology. Valid driver's license and ability to travel within assigned region Strong time management and organizational skills Preferred Skills Experience with HCBS waiver programs and self-directed services Knowledge of person-centered planning principles Background in disability services or long-term care Training or teaching experience Knowledge of continuous quality improvement methodologies Experience with data analysis and reporting tools Experience working remotely. Who We Are: Telligen is one of the most respected population health management organizations in the country. We work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise. Over our 50-year history, health care has evolved - and so have we. What hasn't changed is our deep commitment to those we serve. Our success is built on our ability to adapt, respond to client needs and deliver innovative, mission-driven solutions. Our business is our people and we're seeking talented individuals who share our passion and are ready to take ownership, make an impact and help shape the future of health. Are you Ready? We're on a mission to transform lives and economies by improving health. Ownership: As a 100% employee-owned company, our employee-owners drive our business and share in our success.Community: We show up - for our clients, our communities and each other. Being a responsible corporate partner is part of who we are.Ingenuity: We value bold ideas and calculated risks. Innovation thrives when we challenge the status quo and listen to diverse perspectives.Integrity: We foster a respectful, inclusive, and collaborative environment built on trust and excellence. Thank you for your interest in Telligen!Follow us on Twitter, Facebook, and LinkedIn to learn more about our mission-driven culture and stay up to speed. While we use artificial intelligence tools to enhance our initial screening process, all applications are thoroughly reviewed by our human recruitment team to ensure a fair and comprehensive evaluation of each candidate. Telligen and our affiliates are Equal Opportunity Employers and E-Verify Participants. Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. We will not accept 3rd party solicitations from outside staffing firms.

This position is responsible for inbound and outbound communication in support of case review activities including collection and confirmation of data integrity in support of clinical review services.Essential Functions You will interpret review guidelines to facilitate forward movement of the case review process including requests for clinical information, treatment plans, discharge dates and communicating the authorization for requested services. You will coordinate, distribute and track highly confidential medical information from multiple sources (fax, web, and phone). You will interpret and adhere to URAC standards for assigned programs as well as federal and state requirements. You will ensure quality customer service by responding to phone inquiries from members, physicians, and providers. Prioritize workload to meet program or regulatory time frames. You will provide verbal and written communications of review decisions to include administrative denials. You will complete service/treatment screens for accurate transmission of outcome decision. You will provide general office support and perform miscellaneous duties as assigned. Requirements High school diploma or equivalent required Minimum 2 years of experience working in a customer service or healthcare environment Minimum 2 years of experience with data entry Demonstrated ability to work with confidential information and maintain strict confidentiality Proven ability to work effectively in a deadline-driven environment Excellent written and verbal communication skills Intermediate PC/computer skills Ability to work independently with minimal supervision Able to travel throughout the Des Moines metro area, reliable transportation required for local travel Experience in a health care environment preferred Experience in Iowa Medicaid preferred Experience in working remotely preferred Satisfactory completion of medical terminology course preferred Who We Are: Telligen is one of the most respected population health management organizations in the country. We work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise. Over our 50-year history, health care has evolved - and so have we. What hasn't changed is our deep commitment to those we serve. Our success is built on our ability to adapt, respond to client needs and deliver innovative, mission-driven solutions. Our business is our people and we're seeking talented individuals who share our passion and are ready to take ownership, make an impact and help shape the future of health. Are you Ready? We're on a mission to transform lives and economies by improving health. Ownership: As a 100% employee-owned company, our employee-owners drive our business and share in our success.Community: We show up - for our clients, our communities and each other. Being a responsible corporate partner is part of who we are.Ingenuity: We value bold ideas and calculated risks. Innovation thrives when we challenge the status quo and listen to diverse perspectives.Integrity: We foster a respectful, inclusive, and collaborative environment built on trust and excellence. Thank you for your interest in Telligen!Follow us on Twitter, Facebook, and LinkedIn to learn more about our mission-driven culture and stay up to speed. While we use artificial intelligence tools to enhance our initial screening process, all applications are thoroughly reviewed by our human recruitment team to ensure a fair and comprehensive evaluation of each candidate. Telligen and our affiliates are Equal Opportunity Employers and E-Verify Participants. Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. We will not accept 3rd party solicitations from outside staffing firms.

is eligible for a $2500 retention bonus. The Providence Center Clinical Therapist Home Base Assertive Community Treatment Team (ACTT) will provide outpatient psychotherapy either at The Providence Center or in the community, on a multidisciplinary ACT team. Duties and Responsibilities: Perform, crisis intervention, counseling, screening, client education, referral, treatment planning, and consultation for clients in the program. Perform a comprehensive psychosocial assessment of assigned consumers. Perform and record mental status examination. Assess clinical emergencies, including suicide and danger to others. Collect pertinent data from appropriate collateral sources in accordance with confidentiality guidelines. Maintain confidentiality in accordance with TPC policy and legal requirements. Develop and present, verbally and in writing, a clear clinical formulation based on behavioral data and relevant theory while incorporating psychosocial and family issues. Provide individual, group, and family mental health and/or substance abuse therapy. Develop and implement a plan of care with ongoing client input. Assess clinical emergencies, including suicide and danger to others. Identify specific therapeutic interventions appropriate for specific problems. Carry a small caseload when needed and provide direct service. Provide support counseling, problem-solving, contracts and limit setting. Establish attainable goals with the clients. Encourage clients to attain the highest possible levels of independence. Participate as a member of a multi-disciplinary team in the development and implementation of therapeutic services, to include working with people with substance use challenges. Present verbally a synopsis of actual cases as required. Collaborate with other providers, agencies, and individuals in the consumers' network of care. Maintain knowledge and familiarity of mental health and/or substance abuse and other related community agencies. Perform record keeping in accordance with Health Information Services and TPC requirements. Attend trainings, case presentations and conferences. Participate in the education of other TPC staff. Attend mandatory in service trainings and other trainings required for renewal of licensure. Maintain cooperative relationships with TPC staff, clients, community agencies and the public. Serve on appropriate Center committees. Provide mental health consultation to other community agencies. Requirements: Master s degree in social work or related field and clinical experience required. LICSW, LCSW, LMHC or LMFT preferred. Ability to write reports and correspondence. Ability to speak effectively with consumers, community agencies and Center employees. Bilingual Spanish preferred. Insured auto and valid driver's license. Care New England Health System (CNE) and its member institutions; Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, and our Wellness Center, are trusted organizations fueling the latest advances in medical research, attracting top specialty-trained doctors, and honing renowned services and innovative programs to engage in the important discussions people need to have about their health. Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis. EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status. Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.

As an Iowa Medicaid LTSS Competency-Based Training Specialist, you will be responsible for providing Competency-Based Training (CBT), technical assistance (TA), and consultation for Iowa Medicaid Long-Term Services and Supports (LTSS) providers and case managers. You will provide CBT with the outcomes of a better understanding of, and compliance with, state and federal regulations concerning service provision, increase provider staff competencies in provision of direct services, and to increase the CBT statewide among LTSS service providers and case managers. You will be responsible for Contract Management duties including accountability for contract metrics, deliverables, or project requirements. Essential Functions Collaborate with client to identify training needs and create or procure training for direct support professionals, and/or case managers. Serve as liaison with internal and external customers to ensure projects, plans, and/or products are completed satisfactorily. Serve as a representative of the Company at external client meetings. Promote company expertise and solutions to prospective clients. Partner with team members and internal/external customers as necessary, to determine and evaluate methods to encourage participation in the quality improvement and/or special project initiatives. Maintain positive relationships with internal and external clients to ensure continued participation. Monitors project expenses to ensure alignment with budget. Requirements Four-year degree in a healthcare-related field or equivalent training and/or experience. 8 years experience in healthcare with an emphasis on research and project management. Experience with whole person, team-based approach to care. Knowledge of LTSS, and LTSS Waiver Programs. Understanding of what CBT is and how to make training competency-based in a meaningful way. A strong knowledge of federal state and rules and regulations for these programs and Evidenced-Based Practices. Three years of experience in project management or a major supervisory role with experience managing a major component of a healthcare operation or quality in an environment similar in scope to the Iowa Medicaid LTSS Program. Developing, implementing, and leading provider training. Experience working in a LMS (Learning Management System) Relevant master's degree in Project Management, Learning Management, Staff Development, Education, Mental Health, Social Work, or other relevant fields preferred. Who We Are: Telligen is one of the most respected population health management organizations in the country. We work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise. Over our 50-year history, health care has evolved - and so have we. What hasn't changed is our deep commitment to those we serve. Our success is built on our ability to adapt, respond to client needs and deliver innovative, mission-driven solutions. Our business is our people and we're seeking talented individuals who share our passion and are ready to take ownership, make an impact and help shape the future of health. Are you Ready? We're on a mission to transform lives and economies by improving health. Ownership: As a 100% employee-owned company, our employee-owners drive our business and share in our success.Community: We show up - for our clients, our communities and each other. Being a responsible corporate partner is part of who we are.Ingenuity: We value bold ideas and calculated risks. Innovation thrives when we challenge the status quo and listen to diverse perspectives.Integrity: We foster a respectful, inclusive, and collaborative environment built on trust and excellence. Thank you for your interest in Telligen!Follow us on Twitter, Facebook, and LinkedIn to learn more about our mission-driven culture and stay up to speed. While we use artificial intelligence tools to enhance our initial screening process, all applications are thoroughly reviewed by our human recruitment team to ensure a fair and comprehensive evaluation of each candidate. Telligen and our affiliates are Equal Opportunity Employers and E-Verify Participants. Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. We will not accept 3rd party solicitations from outside staffing firms.

We are so glad you are interested in joining Sutter Health! Organization: SHSO-Population Health Services-Utah Aids patients in obtaining the correct level of care with the appropriate provider at the right time. Provides advance clinical telephone support to Sutter Health patients, other callers, in-basket and other remote support for physicians, and limited in-clinic support. Uses the nursing process, input from physicians, and Sutter Health's approved telephone nursing guidelines and protocols to maintain highly efficient operations, to provide quality care, and to ensure positive patient outcomes. Assesses patients' needs, appropriately dispositions cases, collaborates with the clinic and hospital-based providers to renew electronic prescriptions, identifies hospital and community resources, consultations and referrals, and preforms nursing follow-up activities. Clinical support includes assisting physician partners with message management and other communications within the electronic medical record (EMR) system, as well as limited patient care in an outpatient setting. Job Description: DISCLAIMER Applicants must be a resident of one of the following states to be eligible for consideration for this position: Utah, Idaho, Arizona, Arkansas, Louisiana, Tennessee, Missouri, Montana, or South Carolina. DISCLAIMER 2 This is a Work from Home position, therefore internet minimum speeds of 15 mbps download and 5 mbps upload are required. EDUCATION Graduate of an accredited school of nursing CERTIFICATION & LICENSURE RN-Registered Nurse of California (You can submit application without the CA RN license, but must acquire it prior to your start date if selected). RN-Registered Nurse in State of Residence PREFERRED EXPERIENCE AS TYPICALLY ACQUIRED IN: 2 years' experience of practical nursing in a hospital, clinic, urgent care, or emergency room/department 2 years' experience with several specialties and subspecialties. OB/GYN experience helpful SKILLS AND KNOWLEDGE Professional knowledge of clinical nursing protocols, regulations and institutional standards of care and risk management with an emphasis in the areas of disease processes, emergencies, health sciences and pharmacology. Advanced clinical knowledge of medical diagnoses, procedures, protocols, treatments, and terminology, including a working knowledge of state and federal regulations and guidelines. Solid analytical and project management skills, including the ability to analyze problems, situations, practices, and procedures, reach practical conclusions, recognize alternatives, provide solutions, and institute effective changes. Communication, interpersonal, and interviewing skills, including the ability to build rapport and explain medical lab results or sensitive information clearly and professionally to diverse audiences (patients). Proficient computer skills, including Microsoft Office Suite and experience working electronic medical/health records. Work independently, as well as part of a multidisciplinary team, while demonstrating exceptional attention to detail and organizational skills. Manage multiple priorities/projects simultaneously, sometimes with rapidly changing priorities, while maintaining event/project schedules. Recognize unsafe or emergency situations and respond appropriately and professionally. Ensure the privacy of each patient's protected health information (phi). Analyze possible solutions using precedents, existing departmental guidelines and policies, experience and good judgment to identify and solve standard problems. Build collaborative relationships with peers, physicians, nurses, administrators, and public to provide the highest quality of patient care. Pay Range: Starting wage is $37.19 hourly Job Shift: Varied Schedule: Full Time Shift Hours: 8/10 Blended Days of the Week: Variable Weekend Requirements: Rotating Weekends Benefits: Yes Unions: No Position Status: Non-Exempt Weekly Hours: 32 Employee Status: Regular Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans. Pay Range is $37.19 to $48.71 / hour The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate's experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health's comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.

As the Clinical Quality and Compliance Coordinator you will be responsible for coordinating quality assurance (QA), quality improvement (QI), accreditation, regulatory compliance, and credentialing activities across clinical programs, including Utilization Management (UM), Case Management (CM), and Disease Management (DM). You will provide hands-on support for audit activities, quality improvement initiatives, accreditation readiness, state regulatory filings, credentialing processes, and staff education. You will assist with the development and execution of audit tools and education materials under direction and supports tracking, documentation, and monitoring activities to ensure compliance with URAC, NCQA, state regulatory, and contractual requirements. Essential Functions Support quality assurance (QA) and quality improvement (QI) activities for assigned contracts and clinical programs Track quality deliverables, performance measures, and improvement activities to ensure timely and accurate completion Maintain documentation related to Plan-Do-Study-Act (PDSA) cycles and other quality improvement initiatives Support corrective action plans (CAPs) through documentation, tracking, and follow-up activities Assist with audit and monitoring activities, including clinical file reviews, documentation audits, and compliance checks Execute audits using approved audit tools and methodologies Assist with the development, maintenance, and refinement of audit tools, checklists, and templates under direction, including mapping to applicable accreditation and regulatory standards Compile audit materials, document findings, and assist with trend analysis and issue tracking Maintain audit logs, trackers, and evidence repositories to support remediation and reporting Support accreditation readiness activities for URAC, NCQA, and other applicable accrediting bodies Assist with the collection, organization, and submission of accreditation and regulatory evidence Maintain accreditation trackers, compliance logs, and documentation repositories Support preparation and maintenance of state Utilization Review Organization (URO) applications, renewals, and amendments under direction Support credentialing and recredentialing activities for clinical staff and delegated entities Assist with primary source verification (PSV) documentation collection and file organization Maintain credentialing logs, trackers, and audit documentation Support credentialing audits and corrective action activities as assigned Assist with the development and updating of staff education materials related to quality, compliance, accreditation, and credentialing under direction Draft training materials, job aids, and reference documents and update existing education based on policy or regulatory changes Support delivery of onboarding and refresher education sessions as assigned Track training completion and maintain required documentation Support policy and procedure maintenance through formatting, version control, and document management Prepare draft reports and summaries for leadership and committee review Requirements Registered Nurse (RN) or Licensed Practical Nurse (LPN) license Minimum 2 years of experience in QA/QI, compliance, credentialing, or healthcare operations. Working knowledge of URAC and/or NCQA standards. Experience with clinical documentation review and audit processes. Strong understanding of quality improvement methodologies (e.g., PDSA cycles). Preferred: Bachelor's degree in Nursing, Healthcare Administration, Public Health, or related field. Certification in healthcare quality or compliance (e.g., CPHQ, CPMSM). Experience supporting accreditation surveys, credentialing audits, and state URO filings. Who We Are: Telligen is one of the most respected population health management organizations in the country. We work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise. Over our 50-year history, health care has evolved - and so have we. What hasn't changed is our deep commitment to those we serve. Our success is built on our ability to adapt, respond to client needs and deliver innovative, mission-driven solutions. Our business is our people and we're seeking talented individuals who share our passion and are ready to take ownership, make an impact and help shape the future of health. Are you Ready? We're on a mission to transform lives and economies by improving health. Ownership: As a 100% employee-owned company, our employee-owners drive our business and share in our success.Community: We show up - for our clients, our communities and each other. Being a responsible corporate partner is part of who we are.Ingenuity: We value bold ideas and calculated risks. Innovation thrives when we challenge the status quo and listen to diverse perspectives.Integrity: We foster a respectful, inclusive, and collaborative environment built on trust and excellence. Thank you for your interest in Telligen!Follow us on Twitter, Facebook, and LinkedIn to learn more about our mission-driven culture and stay up to speed. While we use artificial intelligence tools to enhance our initial screening process, all applications are thoroughly reviewed by our human recruitment team to ensure a fair and comprehensive evaluation of each candidate. Telligen and our affiliates are Equal Opportunity Employers and E-Verify Participants. Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. We will not accept 3rd party solicitations from outside staffing firms.

Competitive Compensation & Benefits Package! eligible for - Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan Generous vacation and sick time accrual 12 paid holidays State Retirement (pension plan) 401(k) Plan with employer match Company paid life and disability insurance Wellness Programs Public Service Loan Forgiveness Qualifying Employer See attachment for additional details. Office Location: Remote Option; Available for any of Partners' NC locations (or within 40 miles of NC border) Closing Date: Open Until Filled Primary Purpose of Position: The HEDIS Coding Specialist plays a critical role in ensuring accurate and compliant coding, documentation improvement, and adherence to National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment requirements. With a background in medical coding and clinical practice, the specialist is responsible for reviewing medical records, identifying appropriate diagnosis codes, and ensuring documentation supports coding accuracy. Additionally, they collaborate with healthcare providers to address incomplete or missing clinical documentation, educate on proper coding practices, and facilitate training sessions as needed. By conducting audits, analyzing data, and communicating with internal and external stakeholders, the specialist helps improve coding accuracy, optimize revenue, and enhance the quality of care delivered to patients. Their meticulous attention to detail, strong analytical skills, and compliance expertise contribute to the organization's success in meeting HEDIS reporting requirements and achieving quality improvement goals. Role and Responsibilities: 1. Coding Review: Conduct thorough reviews of medical records to ensure accurate coding and documentation in compliance with National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment requirements. 2. Documentation Improvement: Identify opportunities for documentation improvement to support accurate coding and ensure alignment with coding guidelines and regulatory standards. 3. Provider Education: Collaborate with healthcare providers to educate them on proper documentation practices, coding guidelines, and HEDIS measures. Provide guidance and support to facilitate accurate coding and documentation. 4. Auditing: Perform audits to assess coding accuracy and completeness. Identify discrepancies, coding errors, and areas for improvement through audit findings. 5. Risk Adjustment Coding: Apply expertise in risk adjustment coding to accurately capture and report diagnosis codes relevant to Hierarchical Condition Categories, Risk Adjustment and Managed Care Contract reimbursement initiatives. 6. Data Analysis: Analyze coding and documentation data to identify trends, patterns, and opportunities for improvement. Use data-driven insights to develop strategies for enhancing coding accuracy and documentation completeness. 7. Quality Assurance: Ensure compliance with coding and documentation guidelines, regulatory requirements, and organizational standards. Monitor coding practices and documentation processes to maintain quality and integrity. 8. Provider Support: Serve as a resource for healthcare providers, offering guidance, feedback, and assistance with coding-related inquiries, coding challenges, and documentation queries. 9. Training and Development: Develop and deliver training sessions, workshops, or educational materials to healthcare providers and coding staff on coding best practices, documentation requirements, and HEDIS measures. 10. Collaboration: Collaborate with cross-functional teams, including Quality Improvement, Provider Relations, and Data Analytics, to support quality improvement initiatives, address coding-related issues, and achieve organizational goals. 11. Reporting: Generate reports and documentation to track coding accuracy, documentation improvement efforts, and compliance with HEDIS measures. Communicate findings and recommendations to stakeholders as needed. 12. Continuous Learning: Stay abreast of updates, changes, and advancements in coding guidelines, documentation standards, and regulatory requirements. Continuously enhance knowledge and skills through professional development opportunities. Knowledge, Skills and Abilities: Knowledge: 1. Medical Coding: Comprehensive understanding of ICD-10-CM, CPT, and HCPCS coding systems, including knowledge of coding conventions, guidelines, and updates. 2. HEDIS Measures: Familiarity with National Committee for Quality Assurance (NCQA) HEDIS measures, specifications, and reporting requirements. 3. Risk Adjustment: Understanding of risk adjustment methodologies and concepts, including Hierarchical Condition Categories (HCCs) and CMS risk adjustment models. 4. Clinical Documentation: Knowledge of clinical documentation standards, terminology, and practices to ensure accurate coding and documentation. 5. Regulatory Compliance: Understanding of healthcare regulations, coding guidelines, and compliance standards related to HEDIS reporting, risk adjustment, and medical coding. Skills: 1. Coding Proficiency: Strong coding skills with the ability to accurately assign diagnosis and procedure codes based on clinical documentation. 2. Attention to Detail: Meticulous attention to detail to identify coding discrepancies, documentation deficiencies, and coding errors. 3. Analytical Skills: Ability to analyze coding and documentation data, identify trends, and draw insights to support quality improvement initiatives. 4. Communication Skills: Effective communication skills, both verbal and written, to convey coding guidelines, provide feedback to providers, and collaborate with cross-functional teams. 5. Problem-Solving: Strong problem-solving skills to address coding challenges, resolve discrepancies, and implement solutions to improve coding accuracy and documentation completeness. Abilities: 1. Adaptability: Ability to adapt to changes in coding guidelines, regulatory requirements, and organizational processes related to HEDIS reporting and risk adjustment. 2. Time Management: Effective time management skills to prioritize tasks, meet deadlines, and manage multiple coding projects simultaneously. 3. Collaboration: Ability to collaborate with healthcare providers, coding staff, quality improvement teams, and other stakeholders to achieve coding accuracy and documentation improvement goals. 4. Continuous Learning: Commitment to continuous learning and professional development to stay updated on coding guidelines, HEDIS measures, risk adjustment methodologies, and regulatory changes. 5. Quality Focus: Strong commitment to quality and accuracy in coding and documentation practices to ensure reliable data for HEDIS reporting and support quality improvement efforts. Education Required: Bachelor's degree in health information management (HIM), Health Information Technology, Medical Coding, Nursing, or related healthcare field; OR Associate's degree in health information management or medical Coding with minimum 3 years of medical coding experience Experience Required: Minimum 2-3 years of experience in medical coding and documentation Minimum 1 year of experience with HEDIS measures and reporting Experience with risk adjustment methodologies and HCC coding preferred Technical Skills: Proficiency in ICD-10-CM/PCS, CPT, and HCPCS coding systems Experience with coding software and audit tools Advanced Excel skills for data analysis and reporting Performance Metrics: Demonstrated coding accuracy rate of 95% or higher Ability to code minimum of 20-25 charts per day while maintaining quality standards Education/Experience Preferred: Master's degree in health information management or related field 5+ years of medical coding experience Previous experience in managed care or health plan environment Experience with Epic, Cerner, or other major EHR systems Knowledge of Medicare Advantage and Medicaid managed care operations Knowledge of SQL or other database query languages preferred Licensure/Certifications Required: Current certification from AHIMA (CCS, RHIA, RHIT) or AAPC (CPC, CRC) HEDIS certification or ability to obtain within 6 months of hire

As a Senior Financial Data Analyst, you will play a pivotal role in implementing, administering, and optimizing financial systems to support Telligen's strategic objectives. You will leverage your expertise in financial reporting, accounting, and data management to deliver accurate, timely insights that drive decision-making and operational excellence. This position is ideal for a detail-oriented accounting professional who thrives in a fast-paced environment and enjoys collaborating across teams.Essential Functions You will develop and maintain financial reports that provide real-time, self-service access to contract and business unit performance. You will proactively identify financial and technical trends, communicate insights to internal stakeholders, and ensure accuracy in all reported data. You will collaborate with accounting, finance, technical, operations, and contract teams to prepare and validate reports. You will serve as both accounting and technical lead for financial system implementations and upgrades. You will partner with vendors, Corporate Information Systems, and Information Security teams to ensure timely, secure, and effective system changes. You will evaluate software alternatives and recommend improvements to management. You will oversee the administration, development, testing, and maintenance of finance and administration systems, including General Ledger, Time & Expense, Financial Reporting, Payroll, and Corporate Credit Card interfaces. You will develop and maintain policies, procedures, and controls for system security and report validation. Represent finance and accounting on cross-functional committees and play a key role in technology systems initiatives. You will participate in committees and special projects, and perform miscellaneous duties as assigned to support organizational goals. Requirements Bachelor's degree in Accounting, Finance, Information Systems, or equivalent experience. 5-7 years of experience in accounting, finance or a related field. Experience with report writing, data extraction and financial databases. Ability to learn and apply federal regulations. Deltek Costpoint system experience highly desired. Strong communication skills and ability to work in a fast-paced, deadline-driven environment. Who We Are: Telligen is one of the most respected population health management organizations in the country. We work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise. Over our 50-year history, health care has evolved - and so have we. What hasn't changed is our deep commitment to those we serve. Our success is built on our ability to adapt, respond to client needs and deliver innovative, mission-driven solutions. Our business is our people and we're seeking talented individuals who share our passion and are ready to take ownership, make an impact and help shape the future of health. Are you Ready? We're on a mission to transform lives and economies by improving health. Ownership: As a 100% employee-owned company, our employee-owners drive our business and share in our success.Community: We show up - for our clients, our communities and each other. Being a responsible corporate partner is part of who we are.Ingenuity: We value bold ideas and calculated risks. Innovation thrives when we challenge the status quo and listen to diverse perspectives.Integrity: We foster a respectful, inclusive, and collaborative environment built on trust and excellence. Thank you for your interest in Telligen!Follow us on Twitter, Facebook, and LinkedIn to learn more about our mission-driven culture and stay up to speed. While we use artificial intelligence tools to enhance our initial screening process, all applications are thoroughly reviewed by our human recruitment team to ensure a fair and comprehensive evaluation of each candidate. Telligen and our affiliates are Equal Opportunity Employers and E-Verify Participants. Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. We will not accept 3rd party solicitations from outside staffing firms.

which will work primarily out in the assigned communities.** Join a Mission That Moves With You: Mobile/Remote Care Management across NC Why You'll Love Working Here In 2026, the future of healthcare is in the community. As an I/DD Care Manager at Partners, you aren't just managing files-you are the architect of a better life for individuals with Intellectual and Developmental Disabilities. We offer a role that balances clinical excellence with geographic flexibility, supported by one of the most stable and competitive benefits packages in North Carolina. The Perks of Joining Our Team: Work Where You Live: Fully mobile/remote role serving the counties you live in, work in and call home. Financial Security: State Retirement Pension plan, 401(k) with employer match, company paid life and disability insurance, and an annual incentive bonus. Health & Wellness: Low-deductible medical/dental plans and generous vacation + sick time accruals. Student Loan Relief: We are a Public Service Loan Forgiveness (PSLF) Qualifying Employer-let your work pay off your education. Celebrate Life: 12 paid holidays and dedicated wellness programs. See attachment for additional details. Location: Available for Gaston, Cleveland, Rutherford NC locations; Mobile/Remote position Projected Hiring Range: Depending on Experience Closing Date: Open Until Filled Your Impact & Role As a Partners Care Manager, you will serve as the primary point of contact and navigator for members with I/DD and/or dually diagnosed members. You will lead "Team Based Care," ensuring our members receive holistic support that integrates physical health, behavioral health, and long-term supports and services. What a Typical Week Looks Like: Meet Members Where They Are: Meet members in their communities to assess their current and projected needs to build Person-Centered Care Plans/Individual Support Plans (ISP) to get them closer to achieving their vision for their lives. Integrative Leadership: Facilitate interdisciplinary team meetings to ensure doctors, specialists, providers and families are all moving in the same direction to meet the member's needs. Transition Expert: Guide members through life's big changes-moving from school to adulthood, returning home from care facilities, gaining optimal independence and finding the right combination of paid supports to maintain or increase overall health and wellness. Empowerment: Educate members and families on their rights and connect them to the array of services and our network of providers to secure their future. Who You Are A Mobile Professional: A North Carolina resident and you thrive on the road and value the autonomy of a community-based role. Travel is an essential part of how you connect with those you serve. A Systems Navigator: You understand (or are eager to master) Medicaid regulations, 1915i services, and the Tailored Plan landscape. A Person-Centered Planner: You believe there is no "one size fits all" solution in care management. You bring a voice to vulnerable individuals through your strengths of observation, connecting the dots, supporting their journey through your planning skills. Qualified Candidate to apply:You've earned your degree and put it to work! Congratulations! You are who we are looking for if one of these many different scenarios describe you… You have earned a Bachelor's degree in a human services field like psychology, social work, nursing or other relevant human services field: and you bring with you a minimum of 2 years full-time experience working with individuals with Intellectual and Developmental Disabilities and at least 2 years of your work experience was with people with significant Long-Term Services and Supports (LTSS) needs due to their disability in a setting where they receive care in the community OR You earned a Bachelor's degree outside the human services field and you have at least 4 years full-time experience working with individuals with Intellectual and Developmental Disabilities. and at least 2 years of your work experience was with people with significant Long-Term Services and Supports (LTSS) needs due to their disability in a setting where they receive care in the community OR You earned a Master's degree and have a minimum of 1 year full time experience working with individuals with Intellectual and Developmental Disabilities and at least 2 years of your work experience was with people with significant Long-Term Services and Supports (LTSS) needs due to their disability in a setting where they receive care in the community