Top 79 Alignment healthcare Jobs

Utilization Management Nurse, Lead (Inpatient | Remote | Must have California LVN / RN License)
Alignment Healthcare USA, LLC —Orange, CA
- $85,696 - $128,543 a year
- Full-time
- Remote
- Nursing
- LVN
- RN License
Quick Apply
Bilingual Care Coordinator, Transition of Care (Remote, Mon-Fri, 8am-5pm Pacific Required)
Alignment Healthcare USA, LLC —Orange, CA
- $41,472 - $62,208 a year
- Full-time
- Remote
- Microsoft Word
- Spanish
- Microsoft Excel
Quick Apply
Bilingual Spanish Health Coach and Educator (Home Visits in San Gabriel Valley / Southeast LA, CA | Field Remote)
Alignment Healthcare USA, LLC —Whittier, CA
- $48,373 - $72,559 a year
- Full-time
- Remote
- Spanish
- Microsoft Excel
- Basic math
- Mileage reimbursement
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Remote Auditor, Delegate Claims
Alignment Healthcare USA, LLC —Orange, CA
- $70,823 - $106,234 a year
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- HIPAA
Quick Apply
7d
Advanced Practice Clinician, (NP/PA) JSA (must be able to conduct home visits) North LA / Ventura preferred.
Alignment Healthcare USA, LLC —Los Angeles, CA
- $113,332 - $169,999 a year
- Full-time
- Nursing
- RN License
- Certified Nurse Practitioner
Quick Apply
Bilingual Care Coordinator, Outpatient Case Management (Remote, Mon-Fri, 8am-5pm Pacific Required)
Alignment Healthcare USA, LLC —Orange, CA
- $41,472 - $62,208 a year
- Full-time
- Remote
- Spanish
- Microsoft Excel
- Microsoft Outlook
Quick Apply
4d
Advanced Practice Clinician (NP/PA) JSA (Must be able to conduct home visits, South San Diego preferred)
Alignment Healthcare USA, LLC —San Diego, CA
- $113,332 - $169,999 a year
- Full-time
- RN License
- Certified Nurse Practitioner
- BLS Certification
Quick Apply
Sr. Territory Manage - Field Remote - Must live in San Bernardino/Inland Empire, CA
Alignment Healthcare USA, LLC —San Bernardino, CA
- Full-time
- Remote
- Spanish
- Basic math
- Public speaking
Quick Apply
Clinical Appeals Nurse (Remote | Must have California LVN / RN License)
Alignment Healthcare USA, LLC —Orange, CA
- $77,905 - $116,858 a year
- Full-time
- Remote
- Microsoft Word
- Spanish
- Nursing
Quick Apply
4d
Nurse Practitioner/Physician Assistant-Field Remote
Alignment Healthcare USA, LLC —Tulare, CA
- $98,550 - $147,825 a year
- Online Application
- Remote
- RN License
- Certified Nurse Practitioner
- Computer literacy
- Work from home
Quick Apply
Contact Center Manager - Pharmacy - Hybrid - You must live in Southern California
Alignment Healthcare USA, LLC —Orange, CA
- $58,531 - $87,797 a year
- Full-time
- Hybrid work
- Mid-level
- 3 years
- High school diploma or GED
Quick Apply
12d
Sr. Analyst, Financial Systems: Oracle GL and Financial Close
Alignment Healthcare USA, LLC —Orange, CA
- $113,332 - $169,999 a year
- Weekends as needed
- Remote
- 7 years
- Computer Science
- HIPAA
Quick Apply
13d
Sr. Analyst, Financial Systems: Oracle EPM and FP&A
Alignment Healthcare USA, LLC —Orange, CA
- $113,332 - $169,999 a year
- Weekends as needed
- Remote
- 6 years
- Oracle
- Computer Science
Quick Apply
13d
Direct Agent Strategy & Recruitment Manager - Hybrid - Must live in Orange, CA
Alignment Healthcare USA, LLC —Orange, CA
- $113,332 - $169,999 a year
- Full-time
- Hybrid work
- Public speaking
- Analysis skills
- Bachelor's degree
Quick Apply
Nurse Practitioner/Physician Assistant - Full Time (Must be able to conduct home visits in Wake County, NC)
Alignment Healthcare USA, LLC —Raleigh, NC
- $126,422 - $189,634 a year
- Online Application
- RN License
- Certified Nurse Practitioner
- Computer literacy
Quick Apply
Provider Engagement Specialist – Field Remote (Tulare / Kern / Kings, CA)
Alignment Healthcare USA, LLC —Tulare, CA
- $58,531 - $87,797 a year
- Extended hours
- Remote
- Spanish
- Computer literacy
- Bachelor of Science
Quick Apply
Remote Director, Preferred Networks & Care Routing
Alignment Healthcare USA, LLC —Orange, CA
- $113,332 - $169,999 a year
- Full-time
- Remote
- Nursing
- PMP
- 5 years
Quick Apply
Bilingual Spanish Medical Assistant (Home Visits in El Paso TX | Field Remote)
Alignment Healthcare USA, LLC —El Paso, TX
- $38,569 - $57,853 a year
- Full-time
- Spanish
- CPR Certification
- Microsoft Excel
- Mileage reimbursement
Quick Apply
Bilingual Spanish Social Worker – Field-Based (Home visits in East LA / SGV / Orange County)
Alignment Healthcare USA, LLC —Los Angeles, CA
- $77,905 - $116,858 a year
- Full-time
- Microsoft Word
- Spanish
- Master of Social Work
- Mileage reimbursement
Quick Apply
Hybrid-Sr. Enrollment Representative (Orange, CA)
Alignment Healthcare USA, LLC —Orange, CA
- $41,472 - $62,208 a year
- Full-time
- Hybrid work
- Computer literacy
- Research
- Office
Quick Apply
12d

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Utilization Management Nurse, Lead (Inpatient | Remote | Must have California LVN / RN License)

Alignment Healthcare USA, LLC -
Orange, CA

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Job Details

Full-time
$85,696 - $128,543 a year

Qualifications

Statistics
Nursing
Medicare
Managed care organization experience
CMS
Regulatory compliance
Employee relationship building
CMS regulatory compliance
Math
Medicare regulations
Data interpretation
Leading team collaboration initiatives
Milliman Care Guidelines (MCG Health)
Delegation
Teaching
Stakeholder relationship building
Nursing

Full Job Description

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Utilization Management Nurse Lead is responsible for reviewing requests for inpatient and prior authorization services for all plan members. Works in collaboration with UM leaders and providers to ensure timely processing of referrals to provide the highest quality medical outcomes at the appropriate level of care. Oversees supports the team of UM Nurses with clinical decision-making tasks related to processing UM’s clinical referrals.

Schedule: Monday - Friday, 8:00 AM - 5:00 PM Pacific Time

Job Duties / Responsibilities:
1. Reviews reporting to assign tasks to UM Nurses for completion of time sensitive items.
2. Works closely as a liaison between management and the team to ensure that new cases assigned are worked in a timely manner.
3. Participates in department quality audits and vendor audits to assess timeliness of cases.
5. Effectively communicates and keeps the Utilization Management leadership team informed of all departmental operations, activities, data, program performance, issues or any other pertinent information that would impact the overall program compliance or achievement of internal goals.
6. Assists with team coverage plans as needed. Including jumping into operational support/work queues when needed.
7. Collaborates with other leaders in the department to develop and improve processes and workflows.
8. Acts as a resource to the team, members, providers, and community partners.
9. Establishes and maintains effective interpersonal relationships with staff at all levels, providers, other departments, or programs.
10. Leads, initiates and follows through on multiple projects simultaneously in a team environment.
11. Lead Responsibilities:

Onboarding & training of new hires, including live training sessions and presentations Mentors, trains, audits and coaches a team of UM Nurses to ensure compliance with Alignment policies and procedures and all regulatory requirements. Serves as first-line SME/resource for inpatient UM questions Provides 1:1 coaching/shadowing support when needed Available and approachable/supportive while still helping to maintain accountability Provides guidance to staff or directly manages complicated requests from members, providers, or staff.
12. Other duties as assigned.

Job Requirements

Experience:

Required:

Minimum of (3) consecutive years of related experience in concurrent review and/or prior authorization at managed care organization.
Minimum (2) years of experience using MCG
Preferred: Prior leadership experience preferred

Education:

Required: Successful completion of an accredited Licensed Vocational Nursing or Registered Nursing Program

Specialized Skills:

Required:

Knowledge of Medicare Managed Care Manuals and CMS regulatory requirements.
Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly
Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
Report Analysis Skills: Comprehend and analyze statistical reports.

Licensure:

Required:

Must have and maintain an active, valid, and unrestricted LVN or RN license in California (Non-Compact)
Immediately upon hire, must be willing to obtain LVN and / or RN licensure in Nevada, (Non-compact), Arizona (Compact), North Carolina (Compact), and Texas (Compact) which will be reimbursed by company.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range: $85,696.00 - $128,543.00

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].

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Refine Your Search

alignment healthcare jobs

Utilization Management Nurse, Lead (Inpatient | Remote | Must have California LVN / RN License)

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

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