Billing Systems Manager jobs in Modesto, CA

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

Independent Living Systems (ILS-CA) is committed to enhancing member’s quality of life through innovative health and support solutions that reduce costs, foster independence, improve compliance, and enhance coordination of care. The Care Manager will work as part of a team dedicated to providing high-quality Care Management services to Managed Care Plan Members in a compassionate, effective, timely, and professional manner.

ESSENTIAL FUNCTIONS

1. Engage eligible members and caregivers in available care management services

2. Conduct face to face Health Risk Assessments (HRA) to identify member needs in a timely, engaging, and professional manner

3. Develop, obtain agreement, and manage Individualized Care Plans for members in assigned caseload.

4. Provide consistent and effective care coordination as indicated by the Care Plan

5. Facilitate members access to clinical care, mental health services, and community resources in locations where the HHP member lives, seeks care, or finds most easily accessible as indicated in the Care Plan

6. Connect members to community resources and social supports that may be needed

7. Advocate on behalf of members to access and engage with appropriate health care professionals

8. Employ motivational interviewing and trauma‐informed care practices while interacting with members, caregivers, and family members

9. Arrange transportation and coordinate care team staff to accompany members to office visits according to established protocols, as needed

10.Monitor and support member compliance with clinical and mental health treatment 

plans (including medication)

12. Provide health promotion and self‐management education and support

13. Maintain ongoing communication with members and/or caregivers to ensure engagement in care, building and strengthening relationships.

14. Effectively manage caseload, complying with workflows, as well as timeline and 

documentation requirements

15. Respond appropriately (as specified in workflows and P&Ps)to:

1. safety issues
2. emergencies
3. suspected abuse/neglect
4. other critical situations
5. Document all services in eCare data management system in a timely and accurate manner, according to guidelines and workflows.

16. Collaborate with designated care team members to facilitate access to housing resources and effective transitions of care

17. Foster collaborative relationships with providers, facilities, community resources, etc.

18. Collaborate effectively with hospital staff to ensure successful discharge, as needed

19. Ensure proper continuity of care when cases are transferred between CMs

20. Provide medical interpretation, as necessary

21. Perform other duties as assigned

EDUCATION AND EXPERIENCE

• Education: Licensed Vocational Nurse (LVN), Registered Nurse (RN) or Master of Social Work degree (MSW), Psychologist, or Bachelor of Social Work (BSW). 
• Licensure/Certification: Current California LVN or RN license, BSW or MSW diploma or transcript. Minimum 
• Experience: One or more years’ experience in managed healthcare and/or clinical case management. 
• Experience with the homeless population and chronic medical or mental Illness preferred. Knowledge: Competency utilizing the care management technology platform and the Microsoft Office Platform required. Familiarity with the California Coordinated Care Initiative (CCI) and managed care environment (preferred). 

REQUIRED SKILLS

• Excellent interpersonal skills 
• Excellent verbal and written communication skills 
• Self-disciplined with excellent analytical and problem-solving skills 
• Technological proficiency 
• Ability to work well with others, including staff, clients, members, and the public. 

SALARY:

• Salary range based on Credentials and experience.  

  RN	35.00	38.50
  LVN	28.80	31.25
  BS/BSW	26.00	30.50
  MSW	29.50	33.00

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.