Assess, plan, implement, and coordinate comprehensive care plans to meet individual health needs and ensure cost-effective healthcare delivery.
Serve as a liaison facilitating collaboration among patients, families, physicians, and providers to promote quality of care.
Provide specialized education on disease-specific conditions and remain current with medical trends and procedures.
Arkansas Blue Cross and Blue Shield is a health insurance company providing healthcare coverage and services. They are consistently ranked as a top workplace in Central Arkansas with an inclusive culture and average employee tenure of 10 years.
Provide telephonic case management and utilization review for assigned consumers.
Develop, implement, and monitor individualized care plans to ensure quality and cost-effective outcomes.
Collaborate with healthcare providers, payors, and internal teams to coordinate care.
Cottingham & Butler helps clients through life's toughest moments by providing insurance and benefits solutions. The company fosters a culture of continuous improvement, seeking to hire, train, and grow the best professionals in the industry.
Responsible for using assessment and communication skills to engage patients in need of clinical support, determine priorities, and deliver patient-centered care.
Identify patient education needs through telephonic assessment and collaborate with healthcare teams to coordinate care and keep patients stable at home.
Serve as point of contact for patients, families, and providers, implementing interventions to improve health outcomes and reduce costs.
Vytalize Health is a value-based healthcare company that coordinates care for patients with chronic conditions, aiming to improve outcomes and lower costs. It is a rapidly growing organization with a startup culture, offering a dynamic environment.
Provides active care management and coordinates action plans for members.
Evaluates outcomes and ensures accurate documentation of clinical information.
Serves as member advocate and promotes enrollment in care management programs.
BlueCross BlueShield of South Carolina is a leading health insurance company and administrator of government contracts. With an A+ rating and a diverse family of subsidiaries, they are the largest insurer in South Carolina and employ a dedicated team focused on outstanding customer service.
Collaborate with primary care providers to coordinate care for patients with multiple chronic conditions, ensuring high-quality care through telephonic and in-person outreach.
Conduct transitional care management including post-discharge follow-up and provide education on lifestyle coaching and dietary improvements.
Operate independently to achieve goals, attend regular care team meetings, and perform other duties as assigned.
Privia Health is a technology-driven national physician enablement company that collaborates with medical groups and health systems to optimize practices and improve patient care. The company is led by top industry talent and focuses on scalable operations and cloud-based technology to reduce healthcare costs and improve outcomes.
Provide comprehensive case management services including assessing client needs, developing care plans, coordinating services, and monitoring progress.
Collaborate with healthcare professionals, insurance companies, and stakeholders to ensure seamless care coordination and favorable outcomes.
Maintain accurate documentation, educate clients and families on self-management, and stay current with industry best practices.
MVP Health Care is a not-for-profit health plan provider focused on creating a healthier future through innovation and equity. For over 40 years, they have served New York and Vermont communities with high-quality health plans and have been recognized as a Best Place to Work.
Provide telephonic case management to proactively drive return to work.
Perform utilization review and coordinate care with providers and adjusters.
Evaluate treatment plans and partner with adjusters to achieve optimal outcomes.
AmTrust Financial Services is a fast-growing commercial insurance company providing comprehensive telephonic case management. They foster a diverse and inclusive culture with a focus on attracting and retaining the best talent.
Complete biopsychosocial assessments to identify clinical, behavioral, and social needs.
Proactively identify and resolve care gaps in patient records, ensuring timely clinician review.
Coordinate referrals, follow-up appointments, and community-based care support services.
Knownwell provides weight-inclusive healthcare for all, offering weight management, primary care, nutrition counseling, and health coaching. They are backed by $50M in funding, scaling fast to expand access to evidence-based obesity care nationwide.
Build trusting relationships with patients and providers to address health barriers and coordinate care.
Navigate medical, behavioral, and social systems to connect patients with appropriate resources.
Support value-based care outcomes through proactive outreach, documentation, and quality measures.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. As a growing and innovative organization, we operate with a high degree of agility.
Provide on-demand telephone-based care management services through a 24/7 Nurse Advice Line.
Assess symptoms and concerns of callers to determine urgency and type of care needed.
Coordinate care across the healthcare delivery system and record patient data in medical record systems.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices and improve patient experiences. The company is led by top industry talent and physician leadership, and focuses on reducing healthcare costs and improving outcomes.
Provide exceptional care, disease management and health education to patients.
Support goal setting for individual patients to help them better manage chronic conditions.
Coordinate with other clinical team members to provide an exceptional patient experience.
Salvo Health is a tech-enabled healthcare company focused on chronic gut and metabolic conditions. Backed by leading health investors, it offers a multidisciplinary care team approach with board-certified specialists and digital tools.
Review Home Health prior authorization requests for medical necessity using CMS regulations and Clover clinical guidelines.
Perform initial and concurrent clinical reviews, ensuring appropriate care in the least restrictive setting.
Collaborate with providers and internal teams to support timely decision-making and positive member outcomes.
Clover Health is a healthcare company that uses data and technology to provide affordable, high-quality insurance plans for seniors. The company fosters a remote-first culture with a diverse and mission-driven team focused on improving member outcomes.
Act as the primary point of contact for patients, healthcare providers, and program stakeholders.
Manage patient access, reimbursement, and therapy support processes.
Build trusted relationships with healthcare professionals and ensure coordinated care.
A healthcare services organization that partners with patients and providers to navigate complex treatment processes. The culture is purpose-driven, collaborative, and inclusive, with an emphasis on improving health outcomes.
Implements and supports the philosophy, mission, values, standards, policies, and procedures of The Ohio State University Wexner Medical Center.
Functions within the multidisciplinary team to secure complex pre-authorizations and prevent/appeal clinical denials.
Utilizes clinical knowledge to interpret and apply medical necessity guidelines to determine appropriateness for services provided.
The Ohio State University is a top-20 public university with one of America’s leading academic health centers. They are a team of dedicated colleagues with access to boundless resources.
Serve as the first point of contact for members, triaging communication and coordinating with Maternity Navigators.
Schedule and confirm visits, verify insurance, and maintain real-time visibility into care team schedules.
Build ongoing relationships with members through proactive outreach and help them access non-clinical supports like transportation and WIC.
Nadia Care is reimagining maternity care to improve pregnancy, birth, and postpartum outcomes for underserved communities, with a focus on Black, Brown, and Indigenous families. They are a small startup building trust-based engagement and wrap-around support for expectant mothers.
You are responsible for supporting care delivery by partnering with Advanced Practice Providers to execute individualized care plans for patients with chronic kidney disease, hypertension, diabetes, and congestive heart failure.
This role focuses on enhancing clinical outcomes, patient engagement, and care coordination through education, remote monitoring, medication management, and longitudinal patient support.
Key responsibilities include visit preparation, care plan execution, disease management education, medication management, quality measure support, and cross-functional collaboration.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered approach. They are a growing company building a healthcare delivery model focused on improving patient outcomes and quality of life, with a robust team and culture that emphasizes innovation and support.
Provide telephone support to patients, healthcare professionals, and funding organizations regarding access, reimbursement, compliance, and support programs.
Manage assigned patient cases and projects while following established operational processes and service standards.
Maintain accurate case documentation within program databases, ensuring all activities and interactions are properly recorded.
This role is posted on behalf of a partner company, which manages all applications and next steps. The company focuses on healthcare support and improving patient access to therapies, with a collaborative culture and opportunities for professional growth.
Perform prospective, concurrent, and retrospective utilization reviews for behavioral health services across multiple care settings.
Assess medical necessity and coordinate care with providers, members, and internal teams to ensure appropriate access and treatment.
Support discharge planning, benefit utilization, and regulatory compliance while improving overall care quality.
This company provides high-quality behavioral health coordination and utilization management services to improve member outcomes. They foster a supportive, collaborative environment focused on professional growth and clinical excellence.
Serve as a vital link between patients and healthcare services, coordinating care across primary, specialty, and behavioral health divisions.
Conduct patient assessments and community outreach to engage underserved populations in the Bronx, addressing barriers to care.
Utilize remote patient monitoring tools and electronic health records to track patient progress and adjust care plans.
Essen Health Care is the largest privately held, multispecialty medical group in New York, providing high-quality, compassionate care to underserved residents. Founded in 1999, the company has grown to 50+ locations with 500+ providers, focusing on a population health model and a supportive team environment.
Provide telephonic triage assessments and health education using nursing protocols and algorithms.
Utilize critical thinking and communication skills to manage diverse patient populations.
Work a flexible schedule that includes evenings and weekend shifts from your home office.
Carenet Health provides telephonic clinical assessments, health education, and utilization management services to patients and members. They are a growing organization with a collaborative national team of Registered Nurses, offering work-from-home options and a supportive culture.