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• Work remotely to enhance member management and navigate the healthcare system.
• Promote wellness and assist members in achieving their healthcare goals.
• Conduct telephonic outreach, data analysis, clinical review, and documentation.

Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence, improving patient health, and restoring provider fulfillment.

• Responsible for application of appropriate medical necessity tools to maintain compliance and achieve cost effective and positive patient outcomes.
• Acts as a resource to other team members including UR Tech and AA to support UR and revenue cycle process.
• Utilizes Payer specific screening tools as a resource to assist in the determination process regarding level of service and medical necessity.

Virtua Health strives to connect individuals to the care they need, building a healthier community in South Jersey. They are a Magnet-recognized health system with over 14,000 colleagues, including over 2,850 doctors, physician assistants, and nurse practitioners.

• Provide health assessments and treatment solutions via telephone, video, or chat functions.
• Track and monitor follow-up calls, escalate when appropriate.
• Receive inbound phone calls from patients seeking answers to various medical conditions.

PWNHealth is a national clinician network working to improve early detection and prevention of disease using advanced diagnostics and telehealth. They are a mission-driven, positive culture made up of the best and brightest in the industry.

• Processes acute and post-acute inpatient medical or behavioral health and select intensive outpatient higher level of care requests through review of the submitted request and applicable clinical records
• Collaborates with UM department staff, including Clinical Support Specialists and Medical Directors to make a final determination, and with Care Management staff on discharge planning and transition of care activities.
• Identifies and refers members with complex needs to the appropriate population health and/or care management program.

Capital Blue Cross promises to go the extra mile for our team and our community. Our employees consistently vote us one of the “Best Places to Work in PA, and we foster a flexible environment where your health and wellbeing are prioritized.

• Work primarily remotely with the patient’s medical practice staff and Guidehealth’s Case Management team to manage a targeted population of patients.
• Assist patients in achieving better health outcomes by addressing their questions, connecting them with the medical practice, and implementing high-impact care plans.
• Document patients’ medical history and medical issues accurately in the electronic health record (EHR).

Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence, making great healthcare affordable and improving patient health.

• Establish and direct the strategic vision for the Imagine Pediatrics centralized call center.
• Lead a team of engagement associates that enroll attributed eligible patients into the clinical program.
• Partner with Product, Engineering, and Data teams to inform the technical infrastructure.

Imagine Pediatrics is a tech-enabled, pediatrician-led medical group reimagining care for children with special health care needs. They deliver 24/7 virtual-first and in-home medical, behavioral, and social care, enhancing existing care teams with compassion and an unwavering commitment.

• Deliver comprehensive care navigation and access support for Sana members, ensuring they receive the right care at the right time, place, and cost.
• Collaborate with cross-functional teams, including our virtual care practice and customer support, to provide seamless care navigation services.
• Educate members on their care referral options, empowering them to make informed healthcare decisions.

Sana Benefits is building affordable health plans designed around Sana Care, their integrated care model connecting members with unlimited primary care and expert care navigation at no additional cost to them. They've compiled an innovative team with top talent from across the healthcare and technology industries to deliver engaging, modern, concierge-style healthcare for their members.

The manager will oversee the team that provides patients with on-demand telephone-based care management services via a 24/7 Nurse Advice Line. They will assess caller symptoms/concerns to determine care urgency, refer patients to providers, and give health advice. The manager will handle inbound communications, conduct outbound communications for follow-up, and coordinate with team members to assess and implement patient care plans.

Privia Health™ is a national physician platform transforming the healthcare delivery experience by providing tailored solutions for physicians and providers.

• Provide comprehensive care to adult patients in a fast-paced clinic.
• Collaborate with a multidisciplinary team to ensure patient needs are met.
• Manage symptoms, triage, educate patients, and perform in-clinic procedures.

Dartmouth Health system stretches over New Hampshire and Vermont and offers the quintessential New England experience.

• Manage a panel of seriously ill patients through telemedicine, ensuring visit frequencies align with patient acuity.
• Communicate with patients via phone and video conferencing as outlined in the care plan, providing care within your scope of practice and per provider orders.
• Develop and update care plans based on ongoing assessments, managing medications and coordinating with the Interdisciplinary team and external agencies.

Vynca's mission is to provide comprehensive care for more quality days at home.

• Lead and manage clinical operations teams, ensuring high standards of service delivery and operational compliance.
• Coordinate clinical programs, including utilization management, clinical review, and special initiatives.
• Develop, implement, and maintain operational policies, procedures, and best practices.

Jobgether is a platform that uses AI to match candidates with job opportunities. They aim to ensure applications are reviewed quickly and fairly, connecting top-fitting candidates with hiring companies.

• Provide excellent customer service and product information to patients and providers.
• Support field teams, operations, and sales by delivering timely feedback.
• Proactively create a better patient experience.

Apria Healthcare's mission is to improve the quality of life for patients at home by providing home respiratory services and select medical equipment. They strive to meet the needs of their patients with empathetic, thoughtful, and compassionate people.

This role will serve as a trusted advisor to the customer, ensuring a deep knowledge of the customers’ business enabling us to provide value added solutions. Customer Success Managers for Health Plan ensure optimal adoption of Collective Medical’s technology, align our product’s capabilities with organizational goals, and maintain long term strategic relationships. Own strategic partnerships with clients, acting as the primary point of contact

As a leading health tech company that’s founder-led and privately held, we empower our employees to push boundaries, innovate, and shape the future of healthcare.

The Triage Nurse provides telephone and electronic triage support to firsthand individuals and staff, while also supporting outpatient care coordination. Manage inbound clinical issues from firsthand staff and patients via phone and triage appropriately. Coordinate care with patients’ other providers to ensure seamless health management.

firsthand supports individuals living with SMI (serious mental illness).

• Provide utilization management services, transition of care, and support to members and health care providers.
• Utilize clinical knowledge to interpret medical policy and provide consultation on UM requests.
• Proactively assess and assist members through the continuum of care by utilizing services and resources efficiently.

Wellmark is a mutual insurance company owned by its policy holders across Iowa and South Dakota, and it has built its reputation on over 80 years of trust.