ABOUT US

Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources.

 Position Summary

The Specialist, Clinical Care (CIDD) is responsible for the coordination of care that is being managed by providers, planning, and operational intervention of health plan enrollees. The Specialist, Clinical Care (CIDD) supports comprehensive coordination of medical services including intake, screening and referrals to utilization management and review processes, while promoting and supporting quality effectiveness of healthcare services.

Essential Functions

1. Works with ILS leadership to develop targeted plans to grow and maintain solid relationships with current providers; and establish and build relationships with newly aligned provider to drive plan performance and enrollment.
2. Educating the providers to ensure they understand the contract and the Medicaid and Medicare initiatives regarding this population and the contract requirements.
3. Educating the providers to the mandated best practices for their provider type and identified quality measures.
4. Coordinates with other ILS internal departments to resolve questions or issues regarding prior authorizations, claims submission or payment issues.
5. Perform and participate in field visits including provider contracting, education and training, and networking meetings and events. 
6. Develop programs with community providers which generate recognition and position ILS and its provider network as the preferred provider network for participation and referral
7. Collaborates with the Provider Training Specialist to ensure new provider orientations and ongoing education to providers and their staffs regarding claims, payments, eligibility, utilization management or any other questions impacting provider performance.
8. Conducts provider meetings to share and discuss issues of concern, troubleshoots for issue resolution, and implements an escalation process for discrepancies.
9. Collaborates with Credentialing Department to ensure provider data is correct and include any needed updates.
10. Assists providers to obtain and complete Provider Change Forms as needed.
11. Provides information and participates in management meetings as requested.
12. Regularly meets with ILS leadership to create, revise and adjust strategy for assigned Provider Groups to meet overall performance goals.
13. Performs other duties as required or assigned.

Education and Experience

• Active, Unrestricted Florida RN License is required. BS or MSN preferred. 
• Must have 5 years managed care/health plan experience. 
• Must have 5 years clinical practice experience, e.g., hospital setting, alternative care setting, such as home health or ambulatory care. 
• Utilization Management experience and/or Transitions of Care and discharge Planning experience and/or Disease Management experience and/or Prevention and Wellness experience preferred. 
• Must be fluent in English both written and verbal. Bilingual in English and Spanish or English and Creole preferred. 
• Experience working with the developmentally disabled community preferred.

Required Skills

• Bilingual in Spanish and English
• Ability to Lead team(s), motivate others and engage others at all levels.
• Formal presentation skills required.
• Ability to analyze complete concepts including Provider Reimbursement methodologies, reports and provide resolution within required timeframes.
• Microsoft Office applications.
• Effective Highly organized and self-motivated.
• Capable of working independently.
• Ability to interact with people of all ages and cultural backgrounds.

Travel

 This position requires up to 75% travel. Frequently travel is inside the local area and may be overnight.

EEO STATEMENT 

In compliance with the Drug-Free Workplace Act of 1988, Independent Living Systems has a longstanding commitment to provide a safe, quality-oriented, and productive work environment. Alcohol and drug abuse pose a threat to the health and safety of ILS employees and to the security of the company's equipment and facilities. For these reasons, ILS is committed to the elimination of drug and alcohol use and abuse in the workplace. Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry, or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.