Jobs Posted on the Whova Community Board of LPCA 38th Annual Continuing Education Conference VIRTUAL
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Strategic Sales Director, Southeast
Unite Us Are you a sales professional looking to join a hyper-growth company solving one of our nation’s most challenging problems? If so, please apply to join Unite Us. We are looking for strategic, analytic, and empathetic thinkers with above-exceptional communication skills. We’re moving a market, and you will lead that movement. Opportunity comes with significant upside.
Strategic Sales Director must have a proven track record of enterprise sales success OR strong history of thriving in business, politics, law, military, or social entrepreneurial space. Must be a team player capable of thriving in a fast-moving environment, while carrying a variety of priorities and responsibilities.
The Strategic Sales Director will join our Network Development team and will be responsible for finding and growing new business. This individual will report to the Senior Director for Network Development. Must be comfortable maintaining an active pipeline, identifying market trends and conditions, and helping to design and execute his/her sales plan to address short-term hotspots and long-term strategic goals. Experience in healthcare policy is a plus.
Network Optimization Specialist
Unite Us The Network Optimization Specialist is a highly collaborative individual, who enjoys a fast-paced company and evolving team responsible for growing existing relationships and supporting the change management process with public, private, and not-for-profit organizations by driving action through data and workflow planning. The Network Optimization Specialist helps to develop and execute on strategies to improve the health of coordinated care networks composed of clinical providers, government agencies and community-based organizations. The Network Optimization Specialist will work hand in hand with Network Health Analysts, regional Customer Success Managers, Community Engagement Managers, and Network Hub Support Specialists at Unite Us to create strong coordinated care networks and provide the best customer service and community coordination as possible.
Quality Improvement Abstractor
Louisiana Healthcare Connections Lead data collection and abstraction for company quality measures, including HEDIS, CMS, CHIPRA and/or any other custom measurements. Assess vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards Review medical records and abstract data for HEDIS and other measure sets in compliance with standards Track and report on issues and outcomes related to abstractions and over-reads Communicate outcomes of abstraction and over-sight activities with health plans and vendors when required Perform other quality initiatives as necessary
Quality Specialist I (Call Center)
Louisiana Healthcare Connections Perform quality review to ensure a high level of customer service Perform quality check and audits of inbound and outbound calls to ensure adherence to policies and procedures and high level of customer service Provide feedback on quality review to call center employees and management Identify and monitor trends and quality risks and serve as a resource regarding quality concerns or issues Collaborate with Trainer to identify training needs and assist with the training Participate in continuous quality improvement initiatives Serve as a resource to staff regarding quality concerns Perform quality check on all contact service forms returned ensuring appropriate pricing based on schedules, contracts and member data Review various reports to ensure that contact service forms have been resolved timely and accurately
Louisiana Healthcare Connections Support our Louisiana Healthcare Connection health plan. Create and analyze monthly, quarterly, and annual reports used to track financial performance or comply with State contract requirements Identify trends and developments in competitive environments and presents findings to senior management Collaborate with various functions and leadership roles on strategies to maximize financial performance Support the development and tracking of KPIs that influence the budgetary process Seek process improvement opportunities, process automation and/or process redesign and influence successful implementation
Intern (Financial Analyst Undergraduate-Summer)
Louisiana Healthcare Connections Coordinate, compile and analyze financial information used in budgeting and planning projections across business units and departments. Ensure all significant variances are identified and understood. Ensure requested information is received timely and accurately.
Medical Review Nurse
Louisiana Healthcare Connections Perform medical review provider claims, authorizations, and medical records to achieve resolution of authorization issues that result in claims denials or pended claims. Perform retrospective review for medical necessity appeals against medical review criteria to make benefit of determinations.
Provider Relations Specialist II
Louisiana Healthcare Connections Perform health plan provider orientations and conduct ongoing educational outreach with a focus on improving quality and financial outcomes within the provider network. Act as liaison between providers and the health plan to enhance the business relationship.
Concurrent Review Nurse I
Louisiana Healthcare Connections Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care Conduct discharge planning Educate providers on utilization and medical management processes Provide clinical knowledge and act as a clinical resource to non-clinical team staff Enter and maintain pertinent clinical information in various medical management systems
Behavioral Case Manager
Louisiana Healthcare Connections Perform duties related to the day to day operations of the Integrated Case Management functions to include working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality of life for both behavioral and physical health issues. Assess members’ current functional level and, in collaboration with the member, develop and monitor the Case Management Care Plan, monitor quality of care; assisting with discharge planning, participating in special clinical projects and communicate with departmental and plan administrative staff to facilitate daily operations of the Integrated Case Management functions. Collaborate with both medical and behavioral providers to ensure optimal care for members.
Provider Database Coordinator
Louisiana Healthcare Connections Under supervision, the Provider Database Coordinator ensures the accuracy and completeness of provider data as reflected in Health Net’s databases, systems and provider directory. This position works collaboratively with providers, Network Management and Provider Data Services staff to ensure Health Net provider data is current and accurate. Duties include identifying, researching and resolving inconsistent data.
Community Health Services Representative 1
Louisiana Healthcare Connections Responsible for delivering of a range of activities for individuals who are enrolled in the health plan for Medicaid or and Medicare in order to impact individual health outcomes and provide assistance to the clinical team of nurses and social workers. Activities include, but are not limited to outreach, community education, informal guidance and member support.
Louisiana Healthcare Connections Perform duties to authorize and review utilization of mental health and substance abuse services provided in inpatient, outpatient and intermediate care settings, provide and/or review intakes and initial evaluations, brief focused treatment interventions, monitor quality of care, collect and analyze utilization and cost of care data, assist with discharge planning, arrange transportation; provide member assistance and participate in special utilization projects.
Care Manager I
Louisiana Healthcare Connections Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.
Vice President, Health Equity
Louisiana Healthcare Connections The Health Equity Officer will provide leadership and management to define, implement, and evaluate strategies to achieve equitable access and reduce disparities in clinical care and quality outcomes. This strategy much include tracking, assessing, and improving disparities in care, and supporting the diverse cultural, language, economic, education and health status needs of those served by Managed Health Services.
Health Coach (Behavioral Health)
Louisiana Healthcare Connections Provide telephonic disease management services to individuals with behavioral health issues, including stress and depression. Services may include educating members, coaching and coordinating care.
Prior Authorization Nurse I
Louisiana Healthcare Connections Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests.
Supervisor, Customer Service
Louisiana Healthcare Connections Supervise assigned customer service function at the health plan to meet overall business goals and objectives.
Process Improvement Specialist (Clinical)
Louisiana Healthcare Connections Plan, develop and track process improvement and operational projects related to clinical outcomes for products and ensure integration with delivery systems including service/care coordination.
Customer Service Representative I
Louisiana Healthcare Connections Respond to customer inquiries via telephone and written correspondence in a timely and appropriate manner.
Project Coordinator I
Louisiana Healthcare Connections Provides support with various activities and projects. Track and coordinate projects to ensure prescribed activities are carried out in accordance with specified objectives. Act as a liaison between department and project management software or key project personnel. Coordinate various projects as assigned. Assist in ensuring compliance with departmental policies. Coordinate with key personnel to perform functions as determined by departmental needs. May act as backup to the Administrative Assistant function.