Qureos Mentor

Alignment Healthcare

<div><p>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.</p><p></p>
This is a remote position.<br>
The MRA Coding Auditor supports departmental Quality Assessment audits of internal Coding Analyst team and vendors to ensure accurate and complete data is submitted to CMS. Assists in Risk Adjustment related data audits (RAF, prevalence, clinical documentation improvement, P360, process) audits to identify areas of opportunity for improvement (training, data integrity, chart reviews).<p></p><p><b>
GENERAL DUTIES/RESPONSIBILITIES:</b><br>
1. Supports regular quality assurance (QA) audits of internal Coding Analyst Team to validate and confirm coding &amp; abstracting quality (95% HCC accuracy). These ongoing audits ensure coding quality &amp; performance improvement standards are maintained, achieved &amp; improved per department policies and procedures.<br>
2. Tracks and reports progress of QA audits performed on the coding vendors to verify the coding accuracy and quality of the data submitted to AHP is accurate for submission to CMS.<br>
3. Works with Risk Adjustment Management on any MRA data validation / coding audit to ensure completeness and coding accuracy of all submissions to CMS. This work may encompass reviews of data for reconciliation, data flow integrity, UAT testing, high cost / low risk score members, retrospective chart reviews, or other risk adjustment related data review as directed by Manager.<br>
4. Analyzes and shares audit results with Manager. This information may be used for training physicians and clinical staff, documentation improvement, and system / process improvement.<br>
5. Utilizes, protects, and discloses Alignment Healthcare patients&rsquo; protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.<br>
6. Ensures compliance with all applicable federal, state &amp;local regulations, as well as with institutional/organizational standards, practices, policies &amp; procedures.</p><p>
7. Maintains professional / technical knowledge by attending appropriate educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies. Stay current of industry coding, compliance, and HCC issues. Required to maintain relevant continuing education units (CEUs) in relation to individual coding certifications.<br>
8. Other duties as assigned to meet the organization&rsquo;s needs.</p><p><b>
Job Requirements:</b></p><p><b>
Experience:</b></p><ul><li>Required: Minimum three years of Medicare Risk Adjustment coding in a medical group or health plan setting required</li><li>Preferred:</li></ul><p><b>
Education:</b></p><ul><li>Required: High School Diploma or GED. Completion of a Medical Coding training program.</li><li>Preferred: Bachelor&rsquo;s degree in Business Administration, health Care Management or in a related field</li></ul><p><b>
Training:</b></p><ul><li>Required: Technical School or courses that are required to become a certified coder.</li></ul><p><b>
Specialized Skills:</b></p><ul><li>Required:</li></ul><ul><li>
Knowledge of</li><li>
Proficient user in MS office suite &ndash; Excel, Word, Outlook</li><li>
Previous use of Epic, Allscripts, EZCap</li><li>
Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.</li><li>
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;</li><li>
Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly</li><li>
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.</li><li>
Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.</li><li>
Report Analysis Skills: Comprehend and analyze statistical reports.</li></ul><p><b>
Licensure:</b></p><ul><li>Required: Certified Coder required, CCS, CCS-P, CPC, or CRC</li></ul><p>
Work Environment:</p><p>
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.</p><p>
Essential Physical Functions:</p><p>
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.</p><p></p><p>
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.</p><p>
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.</p>
Pay Range: $64,384.00 - $96,577.00<p>
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
</p><p></p><p>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.</p><p></p><ul><li><i>DISCLAIMER: Please</i><i> 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 </i><i>information. Please</i><i> 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 </i><i>https://reportfraud.ftc.gov/#/</i><i>. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health&rsquo;s talent acquisition team, please email </i><i>careers@ahcusa.com</i><i>.</i></li></ul></div>

MRA Coding Auditor - Remote

<div><p>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.</p><p></p>
Location: Fully Remote (Must be licensed in California)<br>
Schedule: Monday&ndash;Friday, 8:00 AM &ndash; 5:00 PM PT<br>
Language: Bilingual candidates strongly preferred (Spanish and Vietnamese)<br>
<br>
Join the Team That&rsquo;s Redefining Healthcare!<br>
<br>
Are you a compassionate Registered Nurse with a passion for improving the lives of seniors and complex care patients? Join Alignment Health as a Telephonic RN Case Manager for our Special Needs Plan (SNP) members &mdash; all from the comfort of your home!<br>
<br>
This is a fully remote, phone-based position where you'll play a vital role in helping members navigate their care journeys, close gaps in care, and overcome barriers to better health. (HIPAA compliant work space)<p></p><div><div><b>
What You'll Do</b></div><div>
As an <b>RN Case Manager (SNP)</b>, you will:</div><ul><li><div>
Provide telephonic case management to <b>medically complex and chronically ill members</b></div></li><li><div>
Conduct <b>comprehensive health assessments</b> and create individualized care plans</div></li><li><div>
Coordinate care with internal and external partners, including physicians and specialists</div></li><li><div>
Educate members and caregivers on disease management and preventive care</div></li><li><div>
Monitor member progress and advocate for timely, appropriate interventions</div></li><li><div>
Identify and help resolve service or access issues impacting care quality</div></li></ul><div></div><div><b>
Requirements</b></div><div><b>
Must-Haves:</b></div><ul><li><div><b>
Active, unrestricted RN license in California</b> (Non-Compact)</div></li><li><div><b>
Minimum 2 years of clinical nursing experience</b></div></li><li><div><b>
At least 1 year of case management</b> experience</div></li><li>
Proficiency with Microsoft Office (Word, Excel, Outlook)</li></ul><div></div><div><b>
Nice-to-Haves:</b></div><ul><li><div>
Bilingual (Spanish, Korean, Mandarin, etc.)</div></li><li><div>
Previous <b>health plan</b> or <b>IPA</b> experience</div></li><li><div>
Bachelor's Degree in Nursing (BSN)</div></li></ul><div></div><div><b>
Licensure Requirement Upon Hire:</b></div><ul><li><b>
Active, unrestricted RN license in California</b> (Non-Compact)</li><li><div>
Must be willing to obtain RN licensure in <b>Nevada</b>, <b>Arizona</b>, <b>North Carolina</b>, and <b>Texas</b> (company reimburses costs)</div></li></ul><div></div><div><b>
Work Environment</b></div><ul><li><div><b>
Fully remote</b> &mdash; work from anywhere in the U.S., but must work <b>Pacific Time hours</b></div></li><li><div>
All communication is conducted via phone, email and Teams.</div></li><li><div>
Company-provided equipment and IT support included</div></li></ul><div></div><div><b>
Why Join Alignment Health?</b></div><div>
At Alignment, we&rsquo;re changing the way healthcare is delivered for the most vulnerable populations. We're committed to innovation, compassion, and delivering meaningful outcomes &mdash; and we want <b>you</b> to be a part of that journey.</div><div></div><div><b>
Benefits &amp; Perks</b></div><ul><li><div>
Competitive compensation</div></li><li><div>
Full suite of health benefits (medical, dental, vision)</div></li><li><div>
401(k) with employer match</div></li><li><div>
Generous PTO and paid holidays</div></li><li><div>
Career growth and continuing education support</div></li><li><div>
Rewarding referral bonuses for successful hires</div></li></ul><div></div><div><b>
Apply Today</b></div><div>
Be part of something bigger. Bring your skills and compassion to a team that values connection, service, and innovation.</div><div></div><div>
Apply now or refer a colleague who would thrive in this role:</div><div>
https://careers.alignmenthealth.com</div><div></div><div><b>
Note:</b> This position is not open to LVNs. California RN license is required.</div></div><div></div><div><div><div><div><p>
Essential Physical Functions:</p><p>
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.</p><ul><li>
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.</li><li>
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.</li></ul></div></div></div></div>
Pay Range: $77,905.00 - $116,858.00<p>
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
</p><p></p><p>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.</p><p></p><ul><li><i>DISCLAIMER: Please</i><i> 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 </i><i>information. Please</i><i> 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 </i><i>https://reportfraud.ftc.gov/#/</i><i>. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health&rsquo;s talent acquisition team, please email </i><i>careers@ahcusa.com</i><i>.</i></li></ul></div>

Remote Bilingual Spanish Telephonic RN Nurse Case Manager (California RN Required)

<div><p>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.</p><p></p>
This is a field-remote position in Bakersfield or Tulare, Kern or Kings Counties in California.<br>
<br>
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.<p></p><p><b>
Job Duties/Responsibilities:</b></p><p>
Meets or exceeds weekly and monthly qualified lead goals. Helps local market achieve monthly sales goals; works with direct sales teams in lead development and public facing presentations (advertised or non-advertised) Cultivates new and maintains existing relationships with key senior and community influencers that culminate into lead generating events/activities and increase of name awareness for Alignment and its products. 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. 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. Locates, plans, sets-up, attends and presents at Quarterly New Member Orientations and year-round Education events (as needed in a non-virtual event) in the local community. Educates the community on Alignment and its benefits, services and contracted providers and medical groups IPAs available to prospects. Promotes and increases name awareness and brand identity for Alignment and its products. Provides monthly calendar of their planned activities and ensures that all scheduled events filed Maintains weekly summary of activity and submits report on a weekly basis. Performs special projects as assigned to help drive leads for the company. Conducts and leads advertised sales mtgs in their territory. Calls on local Doctor offices to educate on the Alignment products and distribute flyers to generate referrals.</p><p><b><br>
Job Requirements:</b></p><p><b>
Experience:</b></p><ul><li>Required: Minimum two (2) years of experience in grass roots marketing efforts generating leads at local in-person community events. Two years&rsquo; customer service experience.</li><li>Preferred: 5+ years&rsquo; experience in Healthcare. Healthcare marketing experience. Related experience in the Medicare and Medi-Cal Managed Care industry.</li></ul><p><b><br>
Education:</b></p><ul><li>Required: High School Diploma or GED. Bachelor's degree or four (4) years additional experience in lieu of education.</li><li>Preferred: MBA</li></ul><p><b><br>
Training:</b></p><ul><li>Required:</li><li>Preferred:</li></ul><p><b><br>
Specialized Skills:</b></p><ul><li>Required:</li></ul><ul><li>
Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.</li><li>
Computer Skills: Proficient user in MS office suite (Word, Excel and PowerPoint).</li><li>
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;</li><li>
Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly</li><li>
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.</li><li>
Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.</li><li>
Report Analysis Skills: Comprehend and analyze statistical reports.</li></ul><p><b><br>
Licensure:</b></p><ul><li>Required: Valid State driver&rsquo;s license, car insurance, and registration</li><li>Required: State Insurance license OR become licensed within 6 months of hire date</li></ul><p><b><br>
Other:</b></p><ul><li>Required:</li></ul><ul><li>
80% or more travel by car routinely required (In assigned market).</li><li>
Travel by plane required as needed.</li><li>
Maintenance of reliable means of transportation and</li><li>
Extended works hours, as needed.</li><li>
Fully Vaccinated</li><li>
Remote work on approval.</li></ul><p><br>
Essential Physical Functions:</p><p>
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.</p><p></p><p>
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.</p><p>
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.</p>
Pay Range: $53,210.00 - $79,815.00<p>
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
</p><p></p><p>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.</p><p></p><ul><li><i>DISCLAIMER: Please</i><i> 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 </i><i>information. Please</i><i> 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 </i><i>https://reportfraud.ftc.gov/#/</i><i>. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health&rsquo;s talent acquisition team, please email </i><i>careers@ahcusa.com</i><i>.</i></li></ul></div>

Community Outreach Representative - Field Remote in Bakersfield, CA

<div><p>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.</p><p></p>
This is a field-remote position in Charlotte, NC.<br>
<br>
The Broker Account Manager is responsible for the sales and growth of the broker channel and reports to the Vice President of Sales. The Broker Account Manager oversees all channel activity including sales production, recruitment, training and sales strategy to grow the channel while maintaining a favorable acquisition cost for the company.<p></p><p>
GENERAL DUTIES/RESPONSIBILITIES (MAY INCLUDE BUT ARE NOT LIMITED TO):<br>
In overseeing the broker channel, the Broker Manager will:<br>
1. Increases sales and meet or exceed sales expectations through existing active relationships.<br>
2. Builds new selling relationships in existing markets and expansion markets to grow the broker sales channel.<br>
3. Manages provider relationships and assign agents to partner with Medical Groups/IPA&rsquo;s for growth.<br>
4. Oversees agent sales and product training including webinars for new agents, lock-in refresher trainings, and Open Enrollment recertification training.<br>
5. Assists with broker support channels including customer service calls and email inquiries.<br>
6. Oversees interactions with external agents including commissions, discrepancies, enrollment kit fulfillment, certification and contracting/appointment requirements.<br>
7. Ensures CMS compliance with all sales, enrollment processes and events.<br>
8. Oversees compliance at all times to include secret shopping and ride-alongs<br>
9. Provides fair and objective documentation on corrective action plans and/or performance appraisals as directed by company policies and procedures.<br>
10. Provides effective and objective communication to keep managing relationships apprised of any updates and/or changes within department, CMS guidelines, company policies and procedures while keeping strong morale intact.<br>
11. Attends all mandatory management administrative, educational and/or training courses.<br>
12. Other duties as assigned</p><p><b><br>
Job Requirements:</b></p><p><b>
Experience:</b></p><ul><li>Required: Minimum of 2 years of general sales / marketing strategy experience.</li><li>Preferred: Medicare knowledge and/or health insurance background preferred.</li></ul><p><b>
Education:</b></p><ul><li>Required: High School Diploma or GED. Bachelor's degree or four years additional experience in lieu of education.</li><li>Preferred: MBA</li></ul><p><b>
Training:</b></p><ul><li>Required:</li><li>Preferred:</li></ul><p><b>
Specialized Skills:</b></p><ul><li>Required:</li></ul><ul><li>
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;</li><li>
Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.</li><li>
Strong knowledge and understanding of the CMS Marketing Guidelines</li><li>
Must have reliable means of transportation to get to all sales activities and appointments.</li><li>
Extremely organized, detail driven and a self-starter.</li><li>
An innovator and effective leader with the ability to motivate direct team, community affiliates and provider relationships.</li><li>
Excellent public speaking and presentation skills.</li><li>
Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly</li><li>
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.</li><li>
Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.</li><li>
Report Analysis Skills: Comprehend and analyze statistical reports.</li></ul><p><b>
Licensure:</b></p><ul><li>Required: None</li><li>Preferred: Current and active life insurance license within respective selling state</li></ul><p></p><p>
Essential Physical Functions:</p><p>
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.</p><p></p><p>
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.</p><div></div>
Pay Range: $49,486.00 - $74,228.00<p>
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
</p><p></p><p>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.</p><p></p><ul><li><i>DISCLAIMER: Please</i><i> 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 </i><i>information. Please</i><i> 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 </i><i>https://reportfraud.ftc.gov/#/</i><i>. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health&rsquo;s talent acquisition team, please email </i><i>careers@ahcusa.com</i><i>.</i></li></ul></div>

Broker Account Manager - Field Remote - Charlotte, NC

<div><p>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.</p><p></p>
This is a field-remote position in Bakersfield or Tulare, Kern or Kings Counties in California.<br>
<br>
The Broker Account Manager is responsible for the sales and growth of the broker channel and reports to the Vice President of Sales. The Broker Account Manager oversees all channel activity including sales production, recruitment, training and sales strategy to grow the channel while maintaining a favorable acquisition cost for the company.<p></p><p>
GENERAL DUTIES/RESPONSIBILITIES (MAY INCLUDE BUT ARE NOT LIMITED TO):<br>
In overseeing the broker channel, the Broker Manager will:<br>
1. Increases sales and meet or exceed sales expectations through existing active relationships.<br>
2. Builds new selling relationships in existing markets and expansion markets to grow the broker sales channel.<br>
3. Manages provider relationships and assign agents to partner with Medical Groups/IPA&rsquo;s for growth.<br>
4. Oversees agent sales and product training including webinars for new agents, lock-in refresher trainings, and Open Enrollment recertification training.<br>
5. Assists with broker support channels including customer service calls and email inquiries.<br>
6. Oversees interactions with external agents including commissions, discrepancies, enrollment kit fulfillment, certification and contracting/appointment requirements.<br>
7. Ensures CMS compliance with all sales, enrollment processes and events.<br>
8. Oversees compliance at all times to include secret shopping and ride-alongs<br>
9. Provides fair and objective documentation on corrective action plans and/or performance appraisals as directed by company policies and procedures.<br>
10. Provides effective and objective communication to keep managing relationships apprised of any updates and/or changes within department, CMS guidelines, company policies and procedures while keeping strong morale intact.<br>
11. Attends all mandatory management administrative, educational and/or training courses.<br>
12. Other duties as assigned</p><p><b><br>
Job Requirements:</b></p><p><b>
Experience:</b></p><ul><li>Required: Minimum of 2 years of general sales / marketing strategy experience.</li><li>Preferred: Medicare knowledge and/or health insurance background preferred.</li></ul><p><b>
Education:</b></p><ul><li>Required: High School Diploma or GED. Bachelor's degree or four years additional experience in lieu of education.</li><li>Preferred: MBA</li></ul><p><b>
Training:</b></p><ul><li>Required:</li><li>Preferred:</li></ul><p><b>
Specialized Skills:</b></p><ul><li>Required:</li></ul><ul><li>
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;</li><li>
Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.</li><li>
Strong knowledge and understanding of the CMS Marketing Guidelines</li><li>
Must have reliable means of transportation to get to all sales activities and appointments.</li><li>
Extremely organized, detail driven and a self-starter.</li><li>
An innovator and effective leader with the ability to motivate direct team, community affiliates and provider relationships.</li><li>
Excellent public speaking and presentation skills.</li><li>
Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly</li><li>
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.</li><li>
Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.</li><li>
Report Analysis Skills: Comprehend and analyze statistical reports.</li></ul><p><b>
Licensure:</b></p><ul><li>Required: None</li><li>Preferred: Current and active life insurance license within respective selling state</li></ul><p></p><p>
Essential Physical Functions:</p><p>
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.</p><p></p><p>
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.</p><div></div>
Pay Range: $53,210.00 - $79,815.00<p>
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
</p><p></p><p>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.</p><p></p><ul><li><i>DISCLAIMER: Please</i><i> 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 </i><i>information. Please</i><i> 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 </i><i>https://reportfraud.ftc.gov/#/</i><i>. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health&rsquo;s talent acquisition team, please email </i><i>careers@ahcusa.com</i><i>.</i></li></ul></div>

Broker Account Manager - Field Remote - Bakersfield, CA

<div><p>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.</p><p></p>
This position is remote in Orange, CA.<br>
<br>
The Appeals &amp; Grievance Coordinator is responsible for the day-to-day functions of the tracking and trending of all grievances, appeals, and complaints received within the Member Services Department. Acts as the primary investigator and contact person for member and provider grievances and appeals.<p></p><p><b>
GENERAL DUTIES/RESPONSIBILITIES :</b><br>
1. Acknowledges the receipt of all grievance/appeals, and CTM (Complaint Tracking Module).<br>
2. Gathers pertinent and relevant information from the member and/or provider regarding the grievance/appeal, determines the appropriate resolution of the grievance/appeal per standard policies and procedures; and notifies the appropriate parties of the resolution and ensuring that all internal processes are completed to resolve the issue.<br>
3. Composes written correspondence to members in accordance to plan policy and CMS Guidelines.<br>
4. Conducts non-biased, accurate, timely and comprehensive investigation of all the facts related to the grievance/appeal.<br>
5. Thoroughly documents all action taken on behalf of the member or provider to resolve the grievance/appeal.<br>
6. Ensures that all grievances/appeals are processed in adherence to the Centers for Medicare and Medicaid (CMS) guidelines and plan policy.<br>
7. Prepares case files for Medical Director Review and external (including IRE) review of grievances/appeals as appropriate.<br>
8. Prepares clear, objective, accurate and comprehensive case histories for presentation and consideration at committee meetings (including Board of Directors).<br>
9. Maintains accurate and timely documentation, including complete files of all grievances/appeals. Prepares monthly and quarterly reports as requested.<br>
10. Identifies training opportunities and potential system and process improvements relating to grievance/appeal data.<br>
11. Participates in periodic review and update of grievance/appeal policies and procedures to reflect appropriate legal and CMS requirements as well as participate in periodic CMS Audit preparations and regulator meetings/interviews.<br>
12. Other duties as assigned.</p><p></p><p><b>
Job Requirements:</b></p><p><b>
Experience:</b></p><ul><li>Required: Two years&rsquo; experience in data entry and general office background.</li></ul><p>
Three years of customer service experience. Minimum 1 year Member Services or similar experience.</p><ul><li>Preferred: 2 years healthcare or insurance experience in a senior setting.</li></ul><p><b>
Education:</b></p><ul><li>Required: High School Diploma or GED.</li><li>Preferred: Associate degree (A.A.) degree.</li></ul><p><b>
Training:</b></p><ul><li>Required:</li><li>Preferred:</li></ul><p><b>
Specialized Skills:</b></p><ul><li>Required:</li></ul><ul><li>
Knowledge of MediCal and Medicare Managed Care Plans.</li><li>
Ability to Keyboard/Type 40+ words per minute and use the 10-key by touch.</li><li>
Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.</li><li>
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;</li><li>
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.</li><li>
Mathematical Skills: Ability to add and subtract two-digit numbers and to multiply and divide with 10&rsquo;s and 100&rsquo;s. Ability to perform these operations using units of American money and weight measurement, volume, and distance.</li><li>
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.</li><li>
Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.</li><li>Preferred: Bi-lingual (English/Spanish)</li></ul><p><b>
Licensure:</b></p><ul><li>Required: None</li></ul><p></p><p>
Work Environment:
</p><p>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.</p><p>
The noise level in the work environment is usually moderate.</p><p>
Essential Physical Functions:</p><p>
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.</p><p></p><p>
1 While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.</p><p>
2 The employee is frequently required to walk; stand; reach with hands and arms.</p><p>
3 The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.</p><p>
4 The employee must occasionally lift and/or move up to 20 pounds.</p><p>
5 Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.</p>
Pay Range: $44,790.00 - $67,185.00<p>
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
</p><p></p><p>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.</p><p></p><ul><li><i>DISCLAIMER: Please</i><i> 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 </i><i>information. Please</i><i> 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 </i><i>https://reportfraud.ftc.gov/#/</i><i>. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health&rsquo;s talent acquisition team, please email </i><i>careers@ahcusa.com</i><i>.</i></li></ul></div>

Appeals & Grievances Coordinator - Remote - Orange, CA

<div><p>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.</p><p></p>
The Advanced Practice Clinician in the Jump Start Assessment (JSA) program is a physician-led and advanced practice clinician-driven program that is intended to care for and support Alignment Healthcare patients with complex and chronic care needs. Works within an interdisciplinary team environment that includes physicians, nurse practitioners, physician assistants, case managers, and other health care team members to ensure proper delivery of clinical and home-based patient care. Assess&rsquo;, develops, and coordinates options and services promoting quality care in order to achieve optimal health care outcomes while also ensuring cost-effective care complying with Alignment policy and all state and federal regulations. Our members are typically aged 65 and over and home and virtual visits will be between 45 and 60 minutes depending on whether it is an annual or initial visit.<p></p><p><b>
Responsibilities:</b><br>
1. Conduct in-home assessments (with some outpatient clinical work) on health plan members.<br>
2. In-Home Assessments will include obtaining comprehensive history, physical exam, medication review, and appropriate cognitive/depression/safety screenings.<br>
3. Comfort with End-of-life care discussions imperative.<br>
4. Laboratory specimen collection in the home setting when appropriate.<br>
5. Identify diagnoses to be used in active medical management and care management of patients with focus on chronic disease management.<br>
6. Communicate findings of the patient assessment to inform the PCP of potential gaps in care.<br>
7. Provide patient/family/caretaker education, with an emphasis on close monitoring and follow up of patient needs.<br>
8. Emphasis on knowledge of appropriate community resources for referral.<br>
9. Comply with all HIPAA regulations and maintain security of protected health information (PHI).</p><p><b>
Job Requirements:</b></p><p><b>
Experience:</b></p><ul><li>Required: None</li><li>Preferred: One (1) year of prior clinical or home care experience. Previous EMR experience preferred. Experience in care of older adult (geriatric) patients preferred</li></ul><p><b>
Education:</b></p><ul><li>Required: Master&rsquo;s degree from an accredited NP Program or PA program</li></ul><p><b>
Specialized Skills:</b></p><ul><li>Required:</li></ul><ul><li>
Ability to communicate positively, professionally and effectively with others.</li><li>
Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.</li></ul><p><b>
Licensure:</b></p><ul><li>Required: Active California state Nurse Practitioner or Physician Assistant license</li></ul><p>
Active RN License and Furnishing number (Must, upon hire) NP only</p><p>
Active Nurse Practitioner Board Certification/Physician Assistant Certification</p><p>
NPI Number, DEA, Valid BLS</p><p>
Valid California driver license and current automobile insurance</p><ul><li>Preferred:</li></ul><p><b>
Essential Physical Functions:</b></p><p>
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.</p><p>
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.</p><p>
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.</p>
Pay Range: $113,332.00 - $169,999.00<p>
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
</p><p></p><p>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.</p><p></p><ul><li><i>DISCLAIMER: Please</i><i> 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 </i><i>information. Please</i><i> 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 </i><i>https://reportfraud.ftc.gov/#/</i><i>. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health&rsquo;s talent acquisition team, please email </i><i>careers@ahcusa.com</i><i>.</i></li></ul></div>

Advanced Practice Clinician, (NP/PA) JSA (must be able to conduct home visits) North LA / Ventura preferred.

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