We are seeking a Provider Relations Account Executive to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.
About the Role:
The Provider Relations Account Executive plays a pivotal role in fostering and maintaining strong partnerships between our healthcare organization and a diverse network of providers. The Provider Relations Account Executive position is responsible for ensuring seamless communication, addressing provider concerns, and facilitating contract negotiations to optimize service delivery and network growth. The successful candidate will work collaboratively with internal teams to align provider capabilities with organizational goals, enhancing member access and satisfaction. By proactively managing provider relationships, the Account Executive contributes to the overall efficiency and quality of healthcare services offered. Ultimately, this role drives the expansion and retention of a high-performing provider network that supports the organization's mission and strategic objectives.
Minimum Qualifications:
Bachelor’s degree in Healthcare Administration, Business, or a related field.Minimum of 3 years of experience in provider relations, account management, or a similar role within the healthcare industry.Strong knowledge of healthcare provider networks, contract negotiation, and regulatory compliance.Proficiency in Microsoft Office Suite and experience with healthcare management software.Relevant experience may substitute for the educational requirement on a year-for-year basis.Preferred Qualifications:
Master’s degree in Healthcare Administration, Business, or a related discipline.Experience working with managed care organizations or health insurance providers.Familiarity with healthcare data analytics and performance measurement tools.Demonstrated success in managing complex provider networks and multi-stakeholder projects.Certification in healthcare management or provider relations (e.g., Certified Provider Relations Specialist).Responsibilities:
Develop and maintain relationships with practitioners through high-touch communicationIdentify opportunities for growth and expansion within existing accountsCollaborate with internal teams to develop and execute strategic plans that align with business objectivesMeet and exceed performance targets through effective account management and sales strategiesEnsure high levels of provider satisfaction by providing exceptional service and supportWe are seeking a Clinical Care Manager – CA to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.
About the Role:
The Clinical Care Manager plays a pivotal role in coordinating and overseeing patient care to ensure optimal health outcomes. This position involves managing care plans, collaborating with multidisciplinary healthcare teams, and serving as a liaison between patients, families, and providers. The Clinical Care Manager is responsible for assessing patient needs, facilitating access to appropriate services, and monitoring progress to adjust care strategies as necessary. By integrating clinical expertise with strong organizational skills, this role aims to enhance patient satisfaction and improve overall care quality. Ultimately, the Clinical Care Manager ensures that care delivery is efficient, patient-centered, and aligned with best practices and regulatory standards.
Minimum Qualifications:
Bachelor’s degree in Nursing, Social Work, Healthcare Administration, or a related field.Requires at least 5 years of experience in clinical care coordination or case management.Requires knowledge of and experience working with community agencies and programs.Current and valid professional BSW, MSW or LVN, RN, licensure in the State of CA. Requires experience with Medi-Cal eligibility guidelines, application, and renewal/redetermination process.Requires strong problem-solving and customer service skills.Must be a CA Resident and must reside in CA while employedCurrent and valid California (CA) Driver’s License.Must use personal vehicle and current vehicle registration required.Proof of auto insurance required, must maintain CA minimum insurance coverage.CPR Certification requiredRelevant experience may substitute for educational requirement on a year-for-year basis.Preferred Qualifications:
Master’s degree in Nursing, Social Work, Public Health, or Healthcare Administration.Certification in Case Management (CCM) or equivalent credential.Experience working within California’s healthcare system and familiarity with state-specific healthcare policies.Demonstrated expertise in managing chronic disease populations and complex care cases.Bilingual abilities, particularly in Spanish, to effectively communicate with diverse patient populations.Responsibilities:
Develop, implement, and monitor individualized care plans for patients with complex medical needs.Coordinate communication among healthcare providers, patients, and families to ensure continuity of care.Conduct comprehensive assessments to identify patient needs, risks, and barriers to care.Facilitate referrals to appropriate healthcare services and community resources.Track patient progress and outcomes, adjusting care plans as necessary to meet evolving needs.Ensure compliance with healthcare regulations, policies, and quality standards.Provide education and support to patients and families regarding treatment plans and health management.Collaborate with insurance providers and case management teams to optimize resource utilization.We are seeking a Clinical Care Manager – CA to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.
About the Role:
The Clinical Care Manager plays a pivotal role in coordinating and overseeing patient care to ensure optimal health outcomes. This position involves managing care plans, collaborating with multidisciplinary healthcare teams, and serving as a liaison between patients, families, and providers. The Clinical Care Manager is responsible for assessing patient needs, facilitating access to appropriate services, and monitoring progress to adjust care strategies as necessary. By integrating clinical expertise with strong organizational skills, this role aims to enhance patient satisfaction and improve overall care quality. Ultimately, the Clinical Care Manager ensures that care delivery is efficient, patient-centered, and aligned with best practices and regulatory standards.
Minimum Qualifications:
Bachelor’s degree in Nursing, Social Work, Healthcare Administration, or a related field.Requires at least 5 years of experience in clinical care coordination or case management.Requires knowledge of and experience working with community agencies and programs.Current and valid professional BSW, MSW or LVN, RN, licensure in the State of CA. Requires experience with Medi-Cal eligibility guidelines, application, and renewal/redetermination process.Requires strong problem-solving and customer service skills.Must be a CA Resident and must reside in CA while employedCurrent and valid California (CA) Driver’s License.Must use personal vehicle and current vehicle registration required.Proof of auto insurance required, must maintain CA minimum insurance coverage.CPR Certification requiredRelevant experience may substitute for educational requirement on a year-for-year basis.Preferred Qualifications:
Master’s degree in Nursing, Social Work, Public Health, or Healthcare Administration.Certification in Case Management (CCM) or equivalent credential.Experience working within California’s healthcare system and familiarity with state-specific healthcare policies.Demonstrated expertise in managing chronic disease populations and complex care cases.Bilingual abilities, particularly in Spanish, to effectively communicate with diverse patient populations.Responsibilities:
Develop, implement, and monitor individualized care plans for patients with complex medical needs.Coordinate communication among healthcare providers, patients, and families to ensure continuity of care.Conduct comprehensive assessments to identify patient needs, risks, and barriers to care.Facilitate referrals to appropriate healthcare services and community resources.Track patient progress and outcomes, adjusting care plans as necessary to meet evolving needs.Ensure compliance with healthcare regulations, policies, and quality standards.Provide education and support to patients and families regarding treatment plans and health management.Collaborate with insurance providers and case management teams to optimize resource utilization.We are seeking a Clinical Care Manager – CA to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.
About the Role:
The Clinical Care Manager plays a pivotal role in coordinating and overseeing patient care to ensure optimal health outcomes. This position involves managing care plans, collaborating with multidisciplinary healthcare teams, and serving as a liaison between patients, families, and providers. The Clinical Care Manager is responsible for assessing patient needs, facilitating access to appropriate services, and monitoring progress to adjust care strategies as necessary. By integrating clinical expertise with strong organizational skills, this role aims to enhance patient satisfaction and improve overall care quality. Ultimately, the Clinical Care Manager ensures that care delivery is efficient, patient-centered, and aligned with best practices and regulatory standards.
Minimum Qualifications:
Bachelor’s degree in Nursing, Social Work, Healthcare Administration, or a related field.Requires at least 5 years of experience in clinical care coordination or case management.Requires knowledge of and experience working with community agencies and programs.Current and valid professional BSW, MSW or LVN, RN, licensure in the State of CA. Requires experience with Medi-Cal eligibility guidelines, application, and renewal/redetermination process.Requires strong problem-solving and customer service skills.Must be a CA Resident and must reside in CA while employedCurrent and valid California (CA) Driver’s License.Must use personal vehicle and current vehicle registration required.Proof of auto insurance required, must maintain CA minimum insurance coverage.CPR Certification requiredRelevant experience may substitute for educational requirement on a year-for-year basis.Preferred Qualifications:
Master’s degree in Nursing, Social Work, Public Health, or Healthcare Administration.Certification in Case Management (CCM) or equivalent credential.Experience working within California’s healthcare system and familiarity with state-specific healthcare policies.Demonstrated expertise in managing chronic disease populations and complex care cases.Bilingual abilities, particularly in Spanish, to effectively communicate with diverse patient populations.Responsibilities:
Develop, implement, and monitor individualized care plans for patients with complex medical needs.Coordinate communication among healthcare providers, patients, and families to ensure continuity of care.Conduct comprehensive assessments to identify patient needs, risks, and barriers to care.Facilitate referrals to appropriate healthcare services and community resources.Track patient progress and outcomes, adjusting care plans as necessary to meet evolving needs.Ensure compliance with healthcare regulations, policies, and quality standards.Provide education and support to patients and families regarding treatment plans and health management.Collaborate with insurance providers and case management teams to optimize resource utilization.We are seeking a Provider Relations Account Executive to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.
About the Role:
The Provider Relations Account Executive plays an essential role in fostering and maintaining strong partnerships between our healthcare organization and a diverse network of providers. The Provider Relations Account Executive position is responsible for ensuring seamless communication, addressing provider concerns, and facilitating contract negotiations to optimize service delivery and network growth. The Provider Relations Account Executive will work collaboratively with internal teams to align provider capabilities with organizational goals, enhancing member access and satisfaction. By proactively managing provider relationships, the Provider Relations Account Executive contributes to the overall efficiency and quality of healthcare services offered. Ultimately, the Provider Relations Account Executive drives the expansion and retention of a high-performing provider network that supports the organization's mission and strategic objectives.
Minimum Qualifications:
Bachelor’s degree in Healthcare Administration, Business, or a related field.3 years of experience in provider relations, account management, or a similar role within the healthcare industry.Strong knowledge of healthcare provider networks, contract negotiation, and regulatory compliance.Proficiency in Microsoft Office Suite and experience with healthcare management software.Relevant experience may substitute for educational requirement on a year-for-year basis.Preferred Qualifications:
Master’s degree in Healthcare Administration, Business, or a related discipline.Experience working with managed care organizations or health insurance providers.Familiarity with healthcare data analytics and performance measurement tools.Demonstrated success in managing complex provider networks and multi-stakeholder projects.Certification in healthcare management or provider relations (e.g., Certified Provider Relations Specialist).Responsibilities:
Develop and maintain strong collaborative relationships with providers through high-touch communication to ensure network adequacy and quality and other provider performance goals are met.Facilitate the development, negotiation, and execution of provider contracts, ensuring terms meet regulatory standards and organizational policies.Monitor provider performance metrics and work with providers to implement corrective action plans when necessary.Serve as the primary point of contact for all assigned providers, and as a link to various départements to address inquiries, resolve disputes, and maintain positive partnerships.. Maintain accurate records of provider interactions and follow up on outstanding issues to ensure timely resolution.Collaborate with cross-functional teams including care management, compliance, and finance to support provider network initiatives and improve service delivery. opportunities for growth and expansion within existing provider accounts.
Ensure high levels of provider satisfaction by providing exceptional service and support.Page Break
We are seeking a Provider Relations Account Executive to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.
About the Role:
The Provider Relations Account Executive plays an essential role in fostering and maintaining strong partnerships between our healthcare organization and a diverse network of providers. The Provider Relations Account Executive position is responsible for ensuring seamless communication, addressing provider concerns, and facilitating contract negotiations to optimize service delivery and network growth. The Provider Relations Account Executive will work collaboratively with internal teams to align provider capabilities with organizational goals, enhancing member access and satisfaction. By proactively managing provider relationships, the Provider Relations Account Executive contributes to the overall efficiency and quality of healthcare services offered. Ultimately, the Provider Relations Account Executive drives the expansion and retention of a high-performing provider network that supports the organization's mission and strategic objectives.
Minimum Qualifications:
Bachelor’s degree in Healthcare Administration, Business, or a related field.3 years of experience in provider relations, account management, or a similar role within the healthcare industry.Strong knowledge of healthcare provider networks, contract negotiation, and regulatory compliance.Proficiency in Microsoft Office Suite and experience with healthcare management software.Relevant experience may substitute for educational requirement on a year-for-year basis.Preferred Qualifications:
Master’s degree in Healthcare Administration, Business, or a related discipline.Experience working with managed care organizations or health insurance providers.Familiarity with healthcare data analytics and performance measurement tools.Demonstrated success in managing complex provider networks and multi-stakeholder projects.Certification in healthcare management or provider relations (e.g., Certified Provider Relations Specialist).Responsibilities:
Develop and maintain strong collaborative relationships with providers through high-touch communication to ensure network adequacy and quality and other provider performance goals are met.Facilitate the development, negotiation, and execution of provider contracts, ensuring terms meet regulatory standards and organizational policies.Monitor provider performance metrics and work with providers to implement corrective action plans when necessary.Serve as the primary point of contact for all assigned providers, and as a link to various départements to address inquiries, resolve disputes, and maintain positive partnerships.. Maintain accurate records of provider interactions and follow up on outstanding issues to ensure timely resolution.Collaborate with cross-functional teams including care management, compliance, and finance to support provider network initiatives and improve service delivery. opportunities for growth and expansion within existing provider accounts.
Ensure high levels of provider satisfaction by providing exceptional service and support.Page Break
We are seeking a Clinical Advisor to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.
About the Role:
The Clinical Advisor plays a critical role in enhancing the quality and efficiency of healthcare delivery within the organization. This position focuses on evaluating clinical practices, identifying opportunities for improvement, and collaborating with healthcare providers to implement evidence-based strategies that optimize patient outcomes. The advisor serves as a clinical expert and liaison between healthcare teams and administrative leadership, ensuring compliance with regulatory standards and organizational goals. Through data analysis and performance monitoring, the RN Advisor drives continuous quality improvement initiatives that support patient safety and satisfaction. Ultimately, this role contributes to the advancement of healthcare excellence by fostering a culture of accountability, education, and innovation across provider networks.
Minimum Qualifications:
Current and unrestricted Registered Nurse (RN) license in the State of Florida.Bachelor of Science in Nursing (BSN) degree or equivalent.Minimum of 3 years of clinical nursing experience in a healthcare operations, provider relations, quality improvement, managed care, care coordination, MSO operations, provider engagement or related healthcare functions. Demonstrated knowledge of healthcare quality improvement methodologies and performance measurement.Proficiency in analyzing clinical data and generating actionable insights.Preferred Qualifications:
Master’s degree in Nursing, Healthcare Administration, or a related field.Certification in quality improvement or patient safety (e.g., CPHQ, CPPS).Experience working within managed care or health plan environments.Strong familiarity with healthcare regulatory standards such as CMS, Joint Commission, or NCQA.Advanced skills in data analytics software and electronic health record (EHR) systems.Responsibilities:
Demonstrate commitment to Our Mission and models ILS Experience Standards of Excellence.Conduct comprehensive reviews of healthcare provider performance metrics and clinical outcomes to identify areas for improvement.Collaborate with multidisciplinary teams to develop and implement quality improvement plans and best practice guidelines.Provide expert clinical consultation and education to healthcare providers to enhance adherence to evidence-based care standards.Monitor compliance with regulatory requirements and internal policies related to patient care and safety.Analyze healthcare data to generate reports and recommendations that inform leadership decision-making and strategic planning.Facilitate communication between clinical staff and administrative departments to support coordinated care delivery.Participate in the development and delivery of training programs aimed at improving clinical competencies and provider performance.Support initiatives that promote patient-centered care and optimize resource utilization within the healthcare system.Performs other duties as assigned.We are seeking a Supervisor, MMA Care Management to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.
About the Role:
The Supervisor, MMA Care Management plays a vital role in supervising a care management team that supports members enrolled in the Managed Medical Assistant (MMA) Program that qualify to receive care management services. The Supervisor, MMA Care Management ensures care management activities are completed timely, efficiently, compassionately, and in compliance with regulatory standards, contractual requirements, and organizational goals. Key responsibilities include monitoring team performance, reviewing and evaluating work quality, conducting quality assurance activities, and taking corrective action as needed to promote enrollee satisfaction and high-quality service delivery. The Supervisor, MMA Care Management provides ongoing coaching, training, and support to staff while fostering a collaborative team environment that encourages accountability, professional growth, and positive member outcomes. By facilitating communication between Care Managers, leadership, providers, and interdisciplinary partners, the Supervisor, MMA Care Management helps enhance care coordination processes and the overall member experience.
Minimum Qualifications:
State of Florida licensed registered nurse (RN).Two (2) years of pediatric experience and at least two (2) years of relevant experience working with NF, PDN, PPEC, or MFC populations and services, orState of Florida licensed registered nurse (RN) with a minimum of two (2) years of experience with pregnancy or medically complex populations, orMaster’s degree in social work (MSW) with a minimum of two (2) years of pediatric experience and at least two (2) years of relevant experience working with NF, PDN, PPEC, or MFC populations and services.Familiarity with healthcare systems, community resources, and relevant regulatory requirements.Proficiency in documentation, reporting, and use of electronic health records or case management software.Proficient in Microsoft Office applications.Preferred Qualifications:
Certification in Case Management (CCM) or related professional credential.At least one year of supervisory or team leadership experience in healthcare or social services setting.Experience working with diverse member populations and complex care needs.Demonstrated success in quality improvement initiatives or program development.Responsibilities:
Demonstrate commitment to Our Mission and models ILS Experience Standards of Excellence.Lead and supervise a care management team to ensure high-quality, member-centered service delivery and achievement of departmental goals.Monitor care management activities, staff productivity, and caseload performance to ensure timely completion of assessments, care plans, documentation, and follow-up activities.Ensure compliance with organizational policies, contractual requirements, and state/federal regulations through routine oversight, audits, and corrective action as needed.Provide ongoing coaching, performance feedback, training, and professional development to strengthen staff skills, accountability, and engagement.Review dashboards, reports, and operational data to identify trends, address gaps, and implement process improvements that enhance team outcomes.Collaborate with providers, families, interdisciplinary teams, and community resources to support individualized, person-centered care plans and resolve complex member issues.Promote member satisfaction and continuity of care by ensuring responsive service delivery, effective care transitions, and timely resolution of concerns.Perform other duties as assigned. Read LessWe are seeking a Provider Services Advocate to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations
About the Role:
The Provider Services Advocate plays an essential role in supporting healthcare providers by serving as a liaison between providers and the organization. This position ensures that providers receive timely assistance with inquiries, claims, and service issues, ultimately enhancing provider satisfaction and operational efficiency. The Provider Services Advocate will analyze provider concerns, coordinate with internal departments, and facilitate resolutions to complex problems. By maintaining strong relationships and clear communication channels, the role contributes to the seamless delivery of healthcare services. The ultimate goal is to foster a collaborative environment that supports providers in delivering high-quality member care.
Minimum Qualifications:
High school diploma or equivalent.Two years experience in customer service.Knowledge of automated systems and technical adeptness.Demonstrated proficiency in Microsoft programs (i.e., Excel, Word, PowerPoint) required.Preferred Qualifications:
Associate’s or Bachelor’s degree in healthcare administration or related field preferred.Experience working with Medicaid, Medicare, or commercial insurance providers.Experience processing UB04 and CMS 1500 claimsFamiliarity with healthcare regulatory requirements and compliance standards.Certification in healthcare customer service or provider relations.Demonstrated ability to use data analytics tools to identify trends and support decision-making.Responsibilities:
Demonstrate commitment to Our Mission and models ILS Experience Standards of Excellence.Serve as a primary point of contact for healthcare providers seeking assistance with claims, billing, credentialing, and provider service-related inquiries.Investigate and resolve provider issues by collaborating with internal teams such as claims, credentialing, provider relations, and other stakeholders.Maintain accurate records of provider interactions, issues, and resolutions to ensure accountability and continuous improvement.Communicate policy updates, procedural changes, and relevant information to providers to keep them informed and compliant.Identify trends in provider concerns and recommend process improvements to enhance provider experience and operational workflows.Perform other duties as assigned.We are seeking a Medical Management Analyst to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.
About the Role:
The Medical Management Analyst plays an important role in supporting value-based care partners in efforts to improve membership growth, quality of care and service, patient outcomes, and unnecessary utilization of health care resources. The Medical Management Analyst will produce the reports needed to evaluate, monitor, and optimize provider performance, and provide insights into root-cause issues and opportunities for improvement. This role works in collaboration with Provider Relations, Medical Economics, Utilization Management and Quality Improvement to provide education on report generation, provide support in understanding report content, automate reporting, and optimize the quality of the reports. The end result of this role is to provide the data insights to improve provider engagement in the delivery of cost-effective, high-quality care and in creating excellent patient experience.
Minimum Qualifications:
Bachelor’s degree in Healthcare Administration, Public Health, Nursing, Business, or a related field.A minimum of 2 years of experience in health care analytics, medical analysis, or a related role.Strong analytical thinking and a proactive approach to problem solving.Proficiency in data analysis tools and software such as Excel, PowerPoint, SQL, Power Query, Power Pivot. Proven experience automating recurring reports and familiarity with data visualization tools such as Power BI, Tableau. Experience in managed care industry with deep understanding of managed care statistics.Excellent communication and interpersonal skills to effectively collaborate with diverse teams.Preferred Qualifications:
Master’s degree in Healthcare Administration, Public Health, Business Administration, or a related discipline.Experience with electronic health records (EHR) systems and healthcare quality improvement methodologies.Certification such as Certified Professional in Healthcare Quality (CPHQ) or Certified Medical Manager (CMM).Familiarity with healthcare reimbursement models and insurance processes.Advanced skills in statistical analysis software such as SAS, R, or Python.Responsibilities:
Analyze clinical and operational data to assess the effectiveness and efficiency of medical management programs.Develop and implement strategies to improve healthcare delivery, patient outcomes, and cost management.Collaborate with healthcare providers, administrators, and internal stakeholders to identify process improvements and develop reports.Design and produce detailed report templates and presentations that communicate findings, recommendations, and progress to leadership and relevant teams.Provide training and support to stakeholders on report generation and contentMonitor and evaluate partnership performance metrics to ensure alignment with organizational goals.