Jobs at Independent Living Systems, LLC

Process and review prior authorization requests for completeness and necessity, determine authorization needs, perform eligibility verification and non-medical research, route appropriate cases to Clinical Care Specialists, and communicate with providers and internal teams to facilitate timely access to care.

Test and validate claim adjudication system configurations, review and analyze claims and adjustments for correct pricing, identify root causes and trends, recommend policy/procedure improvements, and provide staff training and guidance on coding and policy application.

Serve as a clinical expert to evaluate provider performance, lead quality improvement initiatives, ensure regulatory compliance, analyze clinical data, deliver provider education, and support coordinated, patient-centered care across the health plan.

Manage and lead the IT support team for healthcare operations, ensuring incident resolution, service request fulfillment, HIPAA-compliant processes, vendor management, KPI reporting, training, and alignment with clinical and administrative needs to maintain reliable, secure IT services.

Drive organizational growth by identifying market opportunities, building partnerships with providers, payers, and community partners; develop and execute strategic business plans; collaborate with marketing, operations, and clinical teams; conduct market and competitive analysis to deliver measurable revenue growth.

Design, develop, and execute manual and automated test plans and cases; identify and report defects; analyze test results and communicate findings; collaborate with developers and stakeholders to validate fixes and recommend QA process improvements.

Lead analysis of healthcare business processes, manage claims adjudication configurations, implement contract pricing and provider setups, support client implementations and testing, create workflow documentation, and mentor staff to improve compliance and service delivery.

Lead strategy and operations for provider networks, manage contract negotiations and network adequacy, oversee provider performance and budgets, collaborate with cross-functional teams, and mentor staff to optimize care quality, cost, and regulatory compliance.

Manage full-cycle recruiting: source, screen, interview, and onboard candidates using ATS and social media. Partner with hiring managers for technical, contract, temporary, and permanent roles. Lead college recruiting and events, maintain recruitment records, ensure compliance, and deliver a positive candidate experience.

Manage full-cycle HR functions including onboarding, employee relations, benefits administration, compliance, performance management, and HR recordkeeping. Act as advisor to managers and employees, generate HR reports, and support initiatives that improve engagement, diversity, and organizational performance.

Manage, maintain, and optimize production relational databases (primarily Microsoft SQL Server). Design schemas, tune queries, implement clustering/replication, ensure backup/recovery and security, collaborate with developers and IT teams, troubleshoot issues, and document configurations. On-site role with occasional nights and weekends availability required.

Support attorneys by conducting legal research, drafting and organizing pleadings and discovery, managing case files, preparing trial materials, and communicating with clients and plaintiffs to gather and summarize information for civil litigation matters.

Manage and grow provider network relationships through high-touch communication, contract negotiation, issue resolution, and strategic collaboration with internal teams to improve access, satisfaction, and network performance.

Handle consumer inquiries and complaints via phone and email, document interactions in CRM, analyze feedback to identify trends, coordinate with internal teams to resolve issues, educate consumers about services and policies, and support reporting and process improvements to enhance customer satisfaction.

Design, develop, test, and deploy healthcare software using ASP.NET/C#, .NET Core, SQL, and JavaScript. Collaborate with clinical and product teams to gather requirements, maintain secure, HIPAA-compliant systems, improve performance, and use Git for version control and CI/CD support.

Design, develop, and implement data integration and ETL solutions connecting disparate systems. Monitor, troubleshoot, and support production incidents; maintain documentation; collaborate with cross-functional teams and apply healthcare data standards to improve clinical and operational data flows.

Provide legal counsel and representation focused on healthcare law and compliance. Draft, review, and negotiate contracts and legal documents. Conduct legal research, manage litigation and regulatory matters, represent the organization in proceedings, and advise internal teams to mitigate legal risk and ensure regulatory compliance.

Audit healthcare claims for accuracy and regulatory compliance, identify errors and potential fraud, prepare audit reports with corrective recommendations, collaborate with claims teams and providers to resolve issues, and support internal/external audits and process improvements.

Lead provider relations for IDD services by developing network strategies, managing contracting and negotiations, monitoring provider performance and compliance, collaborating with clinical and quality teams, delivering training, analyzing network data, and representing the organization to stakeholders to ensure high-quality, person-centered care and regulatory adherence.

Perform financial analysis, forecasting, and budgeting to support strategic decisions; build financial models and scenario analyses; monitor financial performance and variances; collaborate with departments to gather claims and operational data; present insights to leadership; ensure regulatory compliance; and identify process improvements and automation opportunities.