Support proactive care coordination services for patients with complex chronic conditions.
Conduct patient outreach, maintain care plans, and support documentation compliance.
Coordinate communication between patients, providers, and healthcare partners.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach. They are committed to improving patient outcomes and improving quality of life.
Document and continuously improve legal and compliance processes, playbooks, and SOPs.
Support Machinify’s compliance programs in planning and executing projects and initiatives, and managing operational frameworks and workflows.
Research laws, regulations, contractual obligations, and internal requirements; synthesize findings into clear, actionable outputs.
Machinify is a leading healthcare intelligence company delivering value, transparency, and efficiency to health plan clients. They have over 85 health plans deployed, including many of the top 20, and representing more than 270 million lives, and they are constantly reimagining what’s possible in healthcare.
This role supports the organization's compliance program.
Monitors adherence to healthcare regulations, identifies risks, and conducts audits.
Provides education to staff on compliance-related matters.
Curai believes access to high-quality healthcare is a fundamental human right, not a privilege. They aim to transform healthcare delivery using AI and clinical expertise, making care affordable and effective. The company focuses on improving health outcomes and is committed to a diverse and inclusive environment.
Provides non-clinical administrative support to Case Managers and Care Coordinators.
Obtains and manages medical documents, ensuring accurate record retrieval.
Prioritizes tasks based on expedited requests with attention to detail.
Spectrum Healthcare Resources (SHR) delivers systems and processes designed to meet the unique needs of Military and VA Health Systems. They provide physician and clinical staffing and management services to United States Military Treatment Facilities, VA clinics and other Federal Agencies.
Own and manage shared inboxes and ensure timely review, triage, escalation and routing of requests
Identify trends, risks, or recurring issues and ensure escalation and action planning
Conduct compliance audits, write corrective action plans and work with department managers to ensure timely completion and compliance with local, state and regulatory requirements
Centene is transforming the health of communities, one person at a time. As a diversified, national organization, they offer competitive benefits and a fresh perspective on workplace flexibility.
Assist clinicians with gathering medical information for patients.
Report any medical concerns monthly for patients.
Completion of PCM as assigned and as needed.
MTC Care is the nation’s leading telemedicine provider of behavioral health care to skilled nursing, assisted living and independent living facilities. Their clinical team includes trained psychiatry and psychology providers, and they are committed to delivering top-notch behavioral health services.
Lead clinicians across Texas, providing clinical leadership and support.
Drive clinical quality by overseeing QA audits and ensuring compliance.
Support onboarding, orientation, and training of new clinicians.
InHome Therapy is dedicated to driving quality care and building high-performing therapy teams. While the job posting does not mention the company size, it seems to have a culture of supporting and developing employees.
Own and execute all CMS Section 111 (MSP) mandatory insurer reporting obligations.
Manage RxDC (Prescription Drug and Health Care Spending) reporting under the Consolidated Appropriations Act (CAA).
Serve as the internal SME on No Surprises Act (NSA) compliance, including Good Faith Estimate (GFE) requirements.
Centivo is an innovative health plan for self-funded employers with a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies and is headquartered in Buffalo, NY. They value being resilient, uncommon, and positive.
Lead end-to-end investigations into compliance and ethics.
Translate complex regulations into practical guidance.
Identify systemic risks and ensure robust remediation.
Rula is dedicated to treating the whole person and aims to create a world where mental health is embraced as an integral part of one's overall well-being. They are a remote-first company that is dedicated to having a culture of inclusion that will support their employees.
Prepare regulatory filings, conduct routine audits, and organize documentation for legal reviews.
Collaborate with attorneys and business leaders to support compliance initiatives and respond to regulatory inquiries.
Provide guidance to internal stakeholders on compliance requirements.
AffirmedRx aims to improve healthcare outcomes by bringing clarity, integrity, and trust to pharmacy benefit management. They are committed to making pharmacy benefits easy to understand, straightforward to access, and always in the best interest of employers. and the lives they impact.
Responsible for submission of the patient’s medical record to CMS or their delegated representatives, other contracted agencies, patients, and privately subpoenaed charts.
Provide administrative support to the Director of Home Health in compliance with organization policies and procedures and applicable laws and regulations.
Develop and maintain tracking tools to assist management with monitoring progress on compliance and accreditation standards.
By The Bay Health, established in 1975, is a non-profit that set the standard for hospice in the U.S. by emphasizing the role of the patient in making important medical decisions. Their spectrum of home-based services includes Skilled Home Health Care, Palliative Care, Adult Hospice Care and Pediatric Care.
Lead EHR Optimization efforts for assigned projects.
Provide EHR expertise related to population health management.
Facilitate data exchange between practices and Aledade.
Aledade empowers independent primary care practices to improve patient outcomes and reduce healthcare costs. They are the largest network of independent primary care in the country, helping practices, health centers and clinics deliver better care to their patients.
Work with internal and external teams to ensure pharmacies meet accreditation requirements.
Assist with staff training and process implementation related to meeting accreditation standards.
Prepare reports and maintain records, and participate in internal/external meetings.
VytlOne (formerly Maxor National Pharmacy Services) is a leading, independent pharmacy solutions platform that improves prescription drug affordability and outcomes. With a workforce of 1,600+ and almost a century of pharmacy experience, they offer the stability of a Fortune 500 company and the energy and innovation of a startup.
Deliver empathetic support to users through email and video calls.
Manage and resolve feedback and support tickets, addressing needs like clinical QA and software troubleshooting.
Educate and empower users through tutorials and personalized guidance to optimize their workflows.
Nabla is committed to bringing back joy to the practice of medicine. They've harnessed machine learning to develop the leading AI assistant that’s restoring the human connection at the heart of healthcare, with over 85,000 clinicians across 130+ healthcare organizations trusting Nabla.
Oversee and prioritize work queues for overdue and expiring patient orders and test results.
Manage patient communications, and process Regional Medication Prior Authorizations.
Collaborate closely with clinic teams to ensure timely follow-up and seamless coordination of patient care tasks.
UnityPoint Health is committed to its team members and has been recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare several years in a row. They champion a culture of belonging where everyone feels valued and respected and equip you with support and development opportunities.
Perform comprehensive medical record and claims review to make payment determinations for Medicare Durable Medical Equipment.
Conduct in-depth claims analysis utilizing ICD-10-CM, AMA-CPT, and HCPCS Level II coding principles.
Make clinical judgment decisions based on clinical experience when applicable.
Empower AI provides AI tools for government to elevate workforce potential. They have three decades of experience solving complex challenges in Health, Defense, and Civilian missions and are headquartered in Reston, VA.
Build trusting relationships with patients, families, and providers, addressing health questions and care needs.
Identify medical, behavioral, social, emotional, and financial needs to support whole‑person care.
Strengthen the connection between patients and healthcare providers by addressing barriers and facilitating communication.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence, with the goal to make great healthcare affordable, improve patient health, and restore fulfillment for providers. They leverage remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers.
Conducts medical necessity reviews to determine appropriate patient class designation.
Performs timely reviews using InterQual Criteria and clinical nursing judgement.
Communicates with the provider team regarding patient class designation and medical necessity.
Emory Healthcare fuels professional journeys with benefits, resources, mentorship, and leadership programs. They offer a supportive environment for career growth.
Perform monthly CCM touchpoints for assigned patient panels.
Evaluate changes in condition using licensed clinical judgment.
Escalate urgent issues based on defined triage pathways.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care. They are committed to improving patient outcomes and improving quality of life by delaying disease progression, shifting care to the home, and accelerating kidney transplants.