Jobs at Independent Living Systems, LLC

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.

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.

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.

Perform internal audits of financial and operational processes, identify risks, recommend corrective actions, prepare audit reports, collaborate with department heads to implement action plans, and maintain audit programs to ensure regulatory compliance and improve quality of care.

Oversee accurate, timely preparation and submission of federal, state, and local healthcare regulatory reports. Lead and mentor a reporting team, collaborate with compliance/finance/IT to validate data, monitor regulatory changes, implement controls and automation, support audits, and use analytics tools to improve reporting efficiency and accuracy.

Lead healthcare business development by identifying opportunities, building partnerships with providers, payers and community partners, developing strategic plans, collaborating with cross-functional teams, and conducting market and competitor analysis to drive revenue growth.

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 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.

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 and maintain enterprise healthcare data architectures, ensuring HIPAA-compliant, scalable data models and integrations. Collaborate with IT, data science, and clinical teams to implement ETL, optimize databases, enforce governance, and support analytics, EHR integration, and data quality for improved patient outcomes.

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.

Lead application management for clinical and administrative systems: gather and validate requirements, analyze workflows, guide implementations and UAT, develop training and materials, monitor application performance, recommend improvements, and ensure regulatory compliance to improve operational efficiency and member outcomes.

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.

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.

Manage and grow provider relationships by negotiating contracts, addressing provider concerns, monitoring performance, coordinating with internal teams, and maintaining accurate records to ensure network adequacy and high provider satisfaction.

Manage and grow provider relationships by negotiating contracts, addressing provider issues, monitoring performance, and coordinating cross-functional teams to ensure network adequacy, compliance, and high provider satisfaction.

Support case managers and social workers by coordinating appointments, maintaining member records, helping complete forms, communicating with members and providers, monitoring progress, and facilitating access to resources while ensuring confidentiality and adherence to policies.

Serve as the bridge between clinical stakeholders and IT to elicit, document, and analyze business requirements, create workflows and use cases, lead UAT, support change management, and work with PMs/development through the SDLC to deliver compliant healthcare IT solutions.

Serve as the bridge between business stakeholders and analytics teams to define regulatory reporting requirements, map processes, identify gaps, design data solutions, validate data, and communicate findings to non-technical audiences. Lead process improvements and work cross-functionally with IT, finance, and operations to ensure compliant, efficient reporting.